Top Line: We can’t believe we’re asking this, but here we go…can triple-negative breast cancer go chemo-free?
The Study: Sacituzumab govitecan is an antibody-drug conjugate (ADC) where the former is an anti-Trop-2 monoclonal antibody and the latter a topoisomerase I inhibitor. In the phase 3 trial ASCENT-04/KEYNOTE-D19, 443 patients with previously untreated PD-L1+ (CPS ≥10) unresectable or metastatic triple-negative breast cancer were randomized to SG + pembro versus standard physician’s choice chemo + pembro. Median progression-free survival was significantly improved from 8 to 11 months (HR 0.65), and objective response rate was numerically higher with the ADC (60%) than with chemo (53%), with more complete responses (13% vs 8%) and more durable responses (median of 17 vs 9 months). Overall survival remains immature, and 81% of those who progressed on chemo crossed over to ADC. Toxicity was predictable: more diarrhea and neutropenia with the ADC; more anemia and thrombocytopenia with chemo. Ultimately more patients discontinued chemo (31%) than ADC (12%), and filgrastim and loperamide earned their keep.
TBL: For the 40% of metastatic triple-negative breast cancer that is PD-L1+, pairing first-line pembrolizumab with the targeted ADC sacituzumab govitecan in place of standard chemo extends progression-free survival with more durable responses. | Tolaney, N Engl J Med 2026
The Study: Sacituzumab govitecan is an antibody-drug conjugate (ADC) where the former is an anti-Trop-2 monoclonal antibody and the latter a topoisomerase I inhibitor. In the phase 3 trial ASCENT-04/KEYNOTE-D19, 443 patients with previously untreated PD-L1+ (CPS ≥10) unresectable or metastatic triple-negative breast cancer were randomized to SG + pembro versus standard physician’s choice chemo + pembro. Median progression-free survival was significantly improved from 8 to 11 months (HR 0.65), and objective response rate was numerically higher with the ADC (60%) than with chemo (53%), with more complete responses (13% vs 8%) and more durable responses (median of 17 vs 9 months). Overall survival remains immature, and 81% of those who progressed on chemo crossed over to ADC. Toxicity was predictable: more diarrhea and neutropenia with the ADC; more anemia and thrombocytopenia with chemo. Ultimately more patients discontinued chemo (31%) than ADC (12%), and filgrastim and loperamide earned their keep.
TBL: For the 40% of metastatic triple-negative breast cancer that is PD-L1+, pairing first-line pembrolizumab with the targeted ADC sacituzumab govitecan in place of standard chemo extends progression-free survival with more durable responses. | Tolaney, N Engl J Med 2026