Abstract P4-07-65: Effect of sacituzumab govitecan vs chemotherapy in HR+/HER2- metastatic breast cancer: patient-reported outcomes from the TROPiCS-02 trial
Authors: Marmé Frederik , Bardia Aditya , Rugo Hope , Schmid Peter , Tolaney Sara M. , Oliveira Mafalda , Schneeweiss Andreas , Shi Ling , Verret Wendy , Gharaibeh Mahdi , Shah Anju , Cortés Javier 
Published: March 2023

Background: For HR+/HER2- metastatic breast cancer (MBC) patients, after resistance to endocrine therapy (ET), treatment options are mostly limited to traditional chemotherapies (CT) that offer poor survival and quality of life (QoL), creating an area of unmet need. The antibody-drug conjugate sacituzumab govitecan (SG) comprises an anti-Trop-2 antibody coupled to SN-38 via a hydrolyzable linker. In the phase 3 TROPiCS-02 trial, heavily pretreated patients with relapsed/refractory HR+/HER2- MBC received SG vs single-agent chemotherapy treatment of physician’s choice (TPC). The study met its primary endpoint of improved progression-free survival with SG vs TPC. Here, we report the effect of SG vs TPC on patient-reported outcomes (PROs) from TROPiCS-02.

Patients and Methods: Patients who had received ≥1 CDK 4/6 inhibitor, ≥1 ET, and 2-4 prior lines of CT were randomized to receive SG (10 mg/kg intravenous on days 1 and 8 of a 21-day treatment cycle) or TPC (capecitabine, eribulin, gemcitabine, or vinorelbine). In the PRO-evaluable population (all randomized patients with an evaluable assessment at baseline (BL) and ≥1 post-BL visit) SG and TPC were compared regarding time to first clinically meaningful worsening (TTD) or death from BL on the EORTC QLQ-C30 domains (≥10 points), EQ-5D-5L health utility index (≥0.08 points), and EQ-VAS (≥7 points). For the EORTC QLQ-C30 function and global health status/QoL domains, patients with a BL score ≥10 and for symptom scales, patients with a BL score ≤90 were included. In the safety population (all randomized patients who received ≥1 dose of study drug), SG and TPC were compared regarding worst level of toxicities during treatment for the PRO-CTCAE items. For TTD, a stratified Cox proportional hazards regression analysis was conducted and the PRO-CTCAE items were summarized descriptively (numbers and percentages).

Results: Of 543 randomized patients, 446 (82%), 445 (82%), and 517 (95%) were included in the PRO-evaluable population (EORTC QLQ-C30: SG vs TPC n=236 vs 210 and EQ-5D-5L: n=238 vs 207) and in the safety population for PRO-CTCAE (SG vs TPC n=268 vs 249), respectively. TTD of EORTC QLQ-C30 global health status/QoL, physical functioning, emotional functioning, fatigue, dyspnea, insomnia, and financial difficulties and EQ-VAS were significantly longer in the SG vs the TPC arm (Table). TTD of EORTC QLQ-C30 diarrhea was significantly shorter for SG vs TPC. For PRO-CTCAE items, decreased appetite, nausea, vomiting, constipation, abdominal pain, shortness of breath, and fatigue were similar between SG and TPC arms, whereas frequency of diarrhea and amount of hair loss were higher in the SG vs TPC arm.

Conclusions: In this trial, SG significantly delayed worsening of overall QoL, physical and emotional functioning, and symptoms like fatigue, dyspnea, and insomnia. Overall, our findings suggest that SG has more favorable effects on PROs compared with TPC in pts with HR+/HER2- MBC.

Table: Time to First Clinically Meaningful Deterioration PRO Scores

Citation Format: Frederik Marmé, Aditya Bardia, Hope Rugo, Peter Schmid, Sara M. Tolaney, Mafalda Oliveira, Andreas Schneeweiss, Ling Shi, Wendy Verret, Mahdi Gharaibeh, Anju Shah, Javier Cortés. Effect of sacituzumab govitecan vs chemotherapy in HR+/HER2- metastatic breast cancer: patient-reported outcomes from the TROPiCS-02 trial [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-07-65.