Clinical outcomes of sacituzumab govitecan in older patients with metastatic triple-negative breast cancer: a multinational real-world study

BACKGROUND: Older adults with metastatic triple-negative breast cancer (mTNBC) remain underrepresented in clinical trials. Although sacituzumab govitecan (SG) improved outcomes in the phase III ASCENT trial, real-world data in older populations remain limited. MATERIALS AND METHODS: We conducted a retrospective, multinational study across 18 oncology centers in Central Europe, including patients with mTNBC treated with SG between August 2021 and May 2025. Patients were stratified by age at SG initiation: <65 vs ≥65 years. Primary endpoints were overall survival (OS) and progression-free survival (PFS). Secondary endpoints included objective response rate (ORR), disease control rate (DCR), treatment modifications, and safety. RESULTS: Among 303 patients, 76 (25.1%) were aged ≥65 years. Older patients had more comorbidities, more prior palliative treatment lines, and more frequent ECOG performance status ≥1. In unadjusted analyses, patients aged ≥65 years had longer median OS (12.8 vs 10.9 months; HR, 0.70; 95% CI, 0.49-0.99; P = 0.045) and PFS (5.4 vs 4.1 months; HR, 0.73; 95% CI, 0.54-0.97; P = 0.031). ORR, DCR, treatment modifications, and grade ≥3 neutropenia were comparable between groups. In multivariable analyses, age was not independently associated with OS or PFS. CONCLUSION: In this selected real-world cohort, patients aged ≥65 years who received SG had outcomes at least comparable to those of younger patients, without an apparent excess severe toxicity. Survival differences were likely influenced by baseline disease characteristics and patient selection rather than chronological age alone.