Strategies for premedication and G-CSF application in sacituzumab govitecan treatment of patients with triple-negative breast cancer: multicenter insights

Sacituzumab govitecan (SG) is approved for advanced triple-negative breast cancer (TNBC) in the second-line setting and beyond, offering improved survival compared to chemotherapy. Adverse events (AEs) commonly include myelosuppression, gastrointestinal disturbances, and hepatic toxicity. Effective premedication and prophylaxis are critical for AE management. This study assessed premedication protocols for SG-treated TNBC patients. A retrospective cohort study across five oncology centers in Poland analyzed premedication regimens for patients completing SG treatment by October 2024. Premedication evaluated included acetaminophen, corticosteroids, antihistamines, 5-HT3 and NK1 receptor antagonists, and granulocyte colony-stimulating factor (G-CSF) when needed. AEs were assessed using National Cancer Institute-Common Terminology Criteria for Adverse Events, version 5.0. Among 67 patients with TNBC who finished their treatment with SG, the mean age at SG initiation was 51.5 ± 12.4 years. Premedication in the first cycle included corticosteroids and 5-HT3 receptor antagonists in 66 (99%) and 65 (97%) patients, respectively; acetaminophen in 57 patients (85%), H1 blockers in 53 patients (79%), and H2 blockers in 52 patients (78%). G-CSF was used as primary prophylaxis in 27 patients (40%) and required in 53 patients (79%) during treatment. Atropine premedication was needed in 4 patients (6%) for grade 3 diarrhea as secondary prophylaxis. Most patients received standardized premedication regimens, but significant variability was observed in G-CSF use for neutropenia prophylaxis. Only 6% of patients required atropine as diarrhea premedication. Practices regarding the use of G-CSF varied across centers, reflecting evolving SmPC guidance and individual risk-based approaches to neutropenia management.