The National Full Cancer Network (NCCN) has updated its guidelines to include sacituzumab govitecan (Trodelvy; Gilead) as a first-line treatment option for patients with metastatic triple-negative breast cancer. According to Jordan Hill, PharmD, BCOP, clinical pharmacy specialist in breast oncology at West Virginia University Cancer Institute, the agent can be used as monotherapy or combined with pembrolizumab (Keytruda; Merck).
The decision to use sacituzumab govitecan alone or in combination with pembrolizumab depends on a patient’s programmed death ligand 1 (PD-L1) status. Patients with a PD-L1 combined positive score (CPS) of 10 or greater may be candidates for the combination therapy.
Updated NCCN Guidelines
Hill explains that the NCCN guidelines have expanded to include sacituzumab govitecan in the first-line setting, either as a single agent or in combination with pembrolizumab. Previously, it was recommended in the second-line setting and beyond.
The biggest difference between using sacituzumab govitecan as a single agent and using it in combination with pembrolizumab is the patient’s PD-L1 status. Patients who are PD-L1–positive are candidates for combination therapy, while those who are PD-L1–negative are candidates for sacituzumab govitecan as a single agent.
Implementing New Treatment Options
One of the biggest challenges pharmacists may face when implementing these new first-line treatment options is waiting for the PD-L1 testing results. Hill notes that triple-negative breast cancer is a very aggressive form of breast cancer, and these patients have metastatic disease, so starting treatment as soon as possible is key.
To reduce the wait time, some institutions have started the process of obtaining insurance approval for the medication while waiting for the PD-L1 testing results. This way, when the result becomes available, the approval process is already underway, which may help reduce the time patients must wait before starting treatment.
In the context of cancer treatment, the ability to start therapy quickly is vital, as it can significantly impact patient outcomes. The updated NCCN guidelines and the use of sacituzumab govitecan in the first-line setting may help improve treatment options for patients with metastatic triple-negative breast cancer.
Related: Sorry, you have been blocked
The PD-L1 testing process can vary depending on the institution, with some conducting testing in-house and others using a send-out test. The wait time for results can range from a few days to several weeks, highlighting the need for efficient testing and approval processes.
Pharmacists play a key role in implementing these new treatment options, as they are responsible for ensuring that patients receive the appropriate therapy in a timely manner. Hill emphasizes that pharmacists should be familiar with the NCCN guidelines and the PD-L1 testing process to provide optimal care for patients with metastatic triple-negative breast cancer.
In addition to understanding the NCCN guidelines, pharmacists should also be aware of the institutional protocols for PD-L1 testing and insurance approval. By streamlining these processes, pharmacists can help reduce the wait time for patients and ensure that they receive the most effective treatment possible.
The use of sacituzumab govitecan in the first-line setting is a significant development in the treatment of metastatic triple-negative breast cancer. As pharmacists, it is essential to stay up-to-date with the latest NCCN guidelines and institutional protocols to provide the best possible care for patients. By working together with healthcare teams, pharmacists can help improve patient outcomes and enhance the quality of care for patients with this aggressive form of breast cancer.
Furthermore, the updated NCCN guidelines highlight the importance of PD-L1 testing in determining the most effective treatment strategy for patients with metastatic triple-negative breast cancer. By understanding the PD-L1 status of patients, healthcare providers can make informed decisions about whether to use sacituzumab govitecan alone or in combination with pembrolizumab.
The implementation of these new treatment options requires a multidisciplinary approach, involving pharmacists, oncologists, and other healthcare professionals. By working together, healthcare teams can ensure that patients receive the most effective treatment possible and improve outcomes for patients with metastatic triple-negative breast cancer.
