What is the effect of gosatuzumab (Todavi) on the immune system?

Gosatuzumab (Trodelvy, generic name: Sacituzumab govitecan) is an antibody drug conjugate (ADC), mainly used to treat cancers such as triple-negative breast cancer (TNBC) and urothelial cancer (UC). It is composed of an antibody moiety combined with a drug component, and is treated by targeting Trop-2 expressing cells. Gosatuzumab provides a targeted therapy solution by accurately attacking cancer cells, but its impact on the immune system is also an important consideration in clinical application.

1. The mechanism of gosatuzumab and the role of the immune system: Gosatuzumab is an antibody drug conjugate (ADC), which is composed of an anti-Trop-2 antibody and a chemotherapy drug (irinotecan). It recognizes and binds to the Trop-2 antigen highly expressed on the surface of tumor cells through the antibody part, and delivers chemotherapy drugs into cancer cells, thereby inhibiting the proliferation of tumor cells. The drug is highly selective and can reduce the poisoning of normal cells by the drug, thereby reducing damage to the immune system while treating tumors. However, despite the clear advantages of gosatuzumab in targeting cancer cells, its impact on the immune system remains an aspect of concern, especially in the context of immunosuppression and immune tolerance.

2. Immunosuppression and gosatuzumab: During the treatment process, gosatuzumab may cause a series of side effects related to the immune system through the chemotherapy drug irinotecan . Irinotecan exerts its anticancer effects through DNA damage and cell cycle inhibition, which may lead to suppression of the immune system, such as leukopenia, lymphopenia, and immunosuppression. These effects may make patients more susceptible to infection, especially during or immediately after treatment. Because the immune system is suppressed, patients need to pay special attention to infection prevention when receiving treatment, and seek medical treatment in time when symptoms of infection are discovered to avoid serious infections.

3. Immune-related adverse reactions: Although gosatuzumab is a targeted therapy, its immune-related adverse reactions still deserve attention. Immune-related adverse reactions (irAEs) refers to side effects caused by activation of the immune system, often associated with immune checkpoint inhibitors or certain targeted therapies. Immune-related adverse reactions of gosatuzumab usually manifest as rash, diarrhea, fever, etc., but in some cases, they may also cause more serious immune system problems, such as immune pneumonitis, immune hepatitis or immune gastroenteritis. Although these immune-related reactions are rare, their impact on the course of treatment cannot be ignored. Clinically, doctors will closely monitor the patient's immune response and take appropriate treatment measures when immune-related adverse reactions occur, usually through immunosuppressants or hormone therapy to alleviate these reactions.

4. Immune system recovery and treatment management: During gosatuzumab treatment, the function of the immune system may be affected, especially under the influence of chemotherapy drugs . A patient's white blood cell and lymphocyte levels may decrease during treatment, resulting in temporary weakening of immune function. To effectively manage the effects of the immune system, doctors often perform regular blood tests to assess a patient's immune function and infection risk. When necessary, measures such as suspending treatment, reducing dosage, or delaying treatment may be taken until the patient's immune system returns to a safer level. In addition, in the later stages of treatment, some patients may experience recovery of the immune system, especially after the drug is discontinued, and the number of immune cells gradually returns to normal levels.

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