What to do if neutropenia occurs during treatment with gosatuzumab/Todavir

Gosatuzumab/Trodelvy (Trodelvy) is an antibody drug conjugate, mainly used for breast cancer. Its active ingredient, the metabolite of irinotecan, SN-38, has an inhibitory effect on the bone marrow hematopoietic system. Therefore, neutropenia is one of the common adverse reactions during the treatment of this drug. Neutropenia not only leads to an increased risk of infection but may also affect the continuity and effectiveness of treatment. During gosatuzumab treatment, if the number of neutrophils is found to decrease significantly, especially if it is less than 1.0 × 10⁹/L, it is usually recommended to suspend administration until the blood picture returns to a safe level. For patients with neutropenia, granulocyte stimulating factor (G-CSF) is generally used clinically for supportive treatment to promote the rapid recovery of white blood cells and thereby reduce the risk of infection.

Physicians should closely monitor the patient's blood count during treatment, especially to assess white blood cell counts and neutrophil levels before the start of each treatment cycle. Once a significant decrease in neutrophil count is found, prompt intervention must be taken. If the patient has fever or other symptoms of infection, anti-infective treatment should be initiated quickly. The management of infection is a crucial link in the treatment process, and the principles of early identification and early treatment should be followed. For patients who have already developed severe neutropenia, clinical considerations may be to extend the treatment interval or reduce the drug dose to prevent recurrence of myelosuppression, especially if toxins accumulate in the patient's body.

In addition, some patients may have weakened SN-38 metabolism due toUGT1A1 gene mutations, and these patients are more likely to develop neutropenia. Therefore, for patients with a family history or previous severe adverse reactions to irinotecan, it is recommended to undergo genetic testing before starting treatment to assess the individual's metabolic capacity. Genetic test results can help doctors personalize treatment and choose appropriate drug dosages and treatment plans.

Reference materials:https://www.trodelvy.com/