Trodelvy Shows Major Progress in Treating Triple-Negative Breast Cancer
A groundbreaking clinical trial has found that the drug Trodelvy, known as a “smart bomb” cancer therapy, significantly outperforms chemotherapy in patients with advanced triple-negative breast cancer (TNBC) who are not eligible for immunotherapy. The results, published in the New England Journal of Medicine, suggest that Trodelvy could soon become the new standard of care for this aggressive and often deadly disease.
“This trial delivers compelling evidence that Trodelvy is clinically superior to chemotherapy as a first-line treatment in patients with newly diagnosed metastatic triple-negative breast cancer,” said Dr. Francisco J. Esteva, chief of Hematology & Medical Oncology at Lenox Hill Hospital, who was not involved in the study.
A Breakthrough for a Highly Aggressive Cancer
Triple-negative breast cancer represents about 15% of all breast cancers and is among the most difficult to treat because it lacks hormone receptors and HER2 protein targets. It progresses quickly and recurs in roughly 42% of cases within five years—three times higher than other types of breast cancer. Only about 15% of patients with metastatic TNBC survive beyond five years after diagnosis.
The new trial compared Trodelvy against standard chemotherapy in patients with locally advanced or metastatic TNBC who had not received prior systemic treatment. The findings were striking: Trodelvy extended progression-free survival to 9.7 months versus 6.9 months with chemotherapy and produced longer-lasting responses—12.2 months compared with 7.2 months for chemo.
How the “Smart Bomb” Works
Trodelvy is an antibody-drug conjugate, a precision medicine that delivers chemotherapy directly to tumor cells while sparing most healthy tissue. “Upon binding to the cancer cell, Trodelvy is internalized and released intracellularly, maximizing tumor cell kill while sparing most healthy tissue,” explained Dr. Esteva. “This targeted action underpins its ‘smart bomb’ designation and contributes to its favorable efficacy and safety profile.”
During the trial, only 4% of patients stopped treatment due to side effects, compared to 12% in the chemotherapy group. The drug showed consistent benefits across all patient subgroups, including those with poor prognoses such as liver metastases and early relapses.
A Potential Paradigm Shift in Cancer Care
Chemotherapy has long been the default treatment for TNBC despite its harsh side effects and limited effectiveness. Esteva believes Trodelvy’s results mark “a paradigm shift in care,” offering patients a chance at longer survival and better quality of life.
“Agents like Trodelvy are vital because they provide more sustained disease control, avoid classic chemotherapy toxicities, and maintain patient quality of life,” he said. “By improving early disease stabilization, they also make patients eligible for further treatments.”
Researchers also note that combining Trodelvy with Merck’s immunotherapy Keytruda reduced the risk of TNBC progression by 35% in earlier trials, reinforcing its potential to transform breast cancer treatment.
“By incorporating Trodelvy earlier in the treatment course, we are positioning patients to live longer and live better—a meaningful advancement in a historically underserved patient population,” Esteva concluded.
