How do you address and mitigate neutropenia in patients with TNBC receiving sacituzumab govitecan in 3rd line or beyond?

For those who develop neutropenia, I generally use neulasta after day 8, but I don't use it with cycle 1 in all comers, unless they are heavily pre-treated and already have a relatively low ANC prior to starting treatment.

I find that some people do have significant neutropenia and others barely any at all. I have had great success with the use of growth factors in those patients who struggle with counts. Additionally, dose reductions can be employed with success as well.

Neutropenia can usually be managed with dose-reduction and/or growth factor support. To minimize extra trips, the provider could consider dose-reduction. In subset analysis from ASCENT, the clinical outcomes were similar in patients who had dose-reduction vs not (Rugo et al, SABCS 2020).

Recommend growth factors for 3 to 4 days weekly.