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SABCS 2021 | ASCENT: sacituzumab govitecan outperforms chemo in Black patients with TNBC

Lisa A. Carey, MD, ScM, FASCO, from the University of North Carolina, Chapel Hill, NC, outlines the pivotal Phase III trial ASCENT (NCT02574455) at the San Antonio Breast Cancer Symposium 2021. The Phase III trial evaluated the performance of the antibody-drug conjugate (ADC) sacituzumab govitecan, as compared to chemotherapy of physicians choice, in patients with triple-negative breast cancer (TNBC). In this Phase III trial, sacituzumab govitecan outperformed chemotherapy. Dr. Carey highlights the significance of the overall results exhibiting consistency in the subgroup analysis of patients who are Black due to the poor prognosis and overrepresentation of TNBC in Black women, as compared to a white cohort of patients. These results suggest ADCs, such as sacituzumab govitecan, may hold the potential to transform the treatment of TNBC to be more precise via the targeted delivery of chemotherapy.

Transcript (edited for clarity)

So, the ASCENT study was a pivotal study. It was a Phase III trial testing sacituzumab govitecan, the antibody-drug conjugate that targets Trop-2 and attaches a cytotoxic to it versus treatment of physicians’ choice. And the parent trial demonstrated a significant improvement and outcomes in pretreated triple-negative breast cancer patients, in favor of the ADC. So this is super important because this is a smart chemo, right? We all like to get to precision medicine as much as we can...

So, the ASCENT study was a pivotal study. It was a Phase III trial testing sacituzumab govitecan, the antibody-drug conjugate that targets Trop-2 and attaches a cytotoxic to it versus treatment of physicians’ choice. And the parent trial demonstrated a significant improvement and outcomes in pretreated triple-negative breast cancer patients, in favor of the ADC. So this is super important because this is a smart chemo, right? We all like to get to precision medicine as much as we can. The truth is that the antibody-drug conjugates are getting us to a targeted way of delivering chemo. And the truth is, in triple-negative breast cancer, chemotherapy is still the coin of the realm in terms of the most effective class of drugs.

So in that overall trial, the sacituzumab govitecan drug, which is commercially called Trodelvy, outperformed chemotherapy of physicians’ choice. What we wanted to look at was the subset of patients who were Black in the parent trial, because you know that they are overrepresented in triple-negative breast cancers to begin with, and their survival is worse compared to a white cohort of patients also with triple-negative breast cancer. And what we found in the ASCENT trial was that the drug outperformed conventional chemotherapy in the Black subset of patients. It was a small number, but it was very consistent with the remainder of the trial in terms of the proportional benefit in favor of the sacituzumab govitecan, which was a very encouraging finding and one that suggests that these antibody-drug conjugates, of which sacituzumab is one, but there are others coming down the pike, in fact, we heard a little bit about a small trial of one today, these are going to be transformative for our patients with triple-negative breast cancer, particularly important for our Black patients who are overrepresented in that type of cancer.

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