Urothelial Carcinoma: Adverse Events From Sacituzumab Govitecan
Scott T. Tagawa, MD, MS, FACP, FASCO, a urothelial carcinoma specialist, discusses adverse events seen in patients receiving sacituzumab govitecan.
EP: 1.Patient Profile 1: A 72-Year-Old With Metastatic Urothelial Carcinoma
EP: 2.Overview of Urothelial Carcinoma
EP: 3.Key Treatment Data in Urothelial Carcinoma
EP: 4.Urothelial Carcinoma: Adverse Events From Sacituzumab Govitecan
EP: 5.Patient Profile 2: A 76-Year-Old With Locally Advanced, Resectable Urothelial Carcinoma
EP: 6.EV-103: Enfortumab Vedotin Plus Pembrolizumab in Urothelial Carcinoma
EP: 7.Urothelial Carcinoma: Safety Profile of Enfortumab Vedotin and Pembrolizumab
EP: 8.Clinical Insights on Evolving Treatment Landscape in Urothelial Carcinoma
Case 1: A 72-Year-Old Man with Metastatic Urothelial Carcinoma
Initial Clinical Presentation:
- A 72-year-old man presented to the clinic with complaints of dizziness and hematuria.
- PMH: Obesity (BMI) and poorly controlled type 2 diabetes (blood sugar, 200 mg/dL)
- SH: Patient does not smoke and occasionally drinks, in social settings.
Initial Clinical Workup:
- CT of chest, abdomen, and pelvis revealed a 3.5-cm mass in the bladder and multiple liver metastases
- ECOG PS 1
- eGFR > 60 mL/min (cisplatin-eligible kidney function)
- Biopsy/pathology confirmed stage IV metastatic urothelial carcinoma
- Molecular testing: FGFR2/3 mutation and fusionnegative
Initial Treatment and Disease Progression:
- Patient received platinum-based chemotherapy with cisplatin.
- Experiences platinum-based peripheral neuropathy (paresthesia) that interrupted the patient’s quality of life.
- Neuropathy was low grade AE (Grade 1)which improved to Grade 0 with supportive care.
- Partial response after 4 cycles of cisplatin; ECOG PS 1
- Imaging showed no growth of existing lesions or new lesions after 4 cycles
- Experiences platinum-based peripheral neuropathy (paresthesia) that interrupted the patient’s quality of life.
- Followed with IO maintenance with avelumab 800 mg IV infusion over 60 minutes every two weeks.
- Following 9 cycles, patient achieved partial response in the lung and bladder.
- Liver function tests, CrCl, and other labs were within normal limits
- No infusion reactions
- 5 months later, disease progression is confirmed
- Patient was initiated on sacituzumab govitecan 10 mg/kg on Days 1 and 28 for 21-day continuous treatment cycle.
- Patient experiences grade 3 neutropenia at the time of schedule treatment.
- Delay dosing by 2 weeks until recovery to less than grade 1. Managed with 25% dose reduction and administration of G-CSF.
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