Pattern of granulocyte colony stimulating growth factors (G-CSGF) usage in patients treated with sacituzumab govitecan: A real world multicenter study using the TriNetX database.

Abstract

e13145 Background: Sacituzumab Govitecan (SG) a Trop2-targeted antibody-drug conjugate (ADC) was reported to cause neutropenia among 63% patients in clinical trials [Bardia, NEJM 2021]. G-CSFs are often used to manage chemotherapy-induced neutropenia. However, data on the pattern of G-CSF use among patients receiving SG in real-world settings remain limited. This study aims to evaluate the utilization patterns of G-CSFs in patients treated with Sacituzumab Govitecan and analyze their demographic and clinical characteristics that put them at greater risk for neutropenia using using the TriNetX database. Methods: We conducted a retrospective study using the TriNetX database. SG and G-CSF (filgrastim or PEG filgrastim) were identified using RxNorm coding (2360231, 68442, 338036) and neutropenia was identified using ICD-10-CM code. We limited neutropenia or G-CSF usage events to occur within 21 days of SG. We compared cohort SG with neutropenia to SG without neutropenia using TrinetX built-in feature (outcome comparison) for demographic, comorbidities and laboratory parameters. We analyzed the incidence of G-CSF usage in the two cohorts. Results: We analyzed 117 million+ de-identified patients, of which 2317 patients received SG. 28% (639/2317) of the SG recipient had neutropenia (SGN+ cohort), while 72% (N = 1678) did not have neutropenia (SGN- cohort) within 21 days of SG. When the two cohorts were compared, factors associated with neutropenia were Obesity (32% v/s 21%, p < 0.0001), Diabetes Mellitus (25% v/s 18%, p 0.0002), Hypertension (56% v/s 42%, p < 0.0001), Ischemic heart disease (20% v/s 15%, p 0.0034), Cerebrovascular accident (12% v/s 9%, p 0.0203), Chronic kidney disease (17% v/s 12%, p 0.0038). The pattern of use of G-CSF usage differed among the two groups. Among SGN+ cohort, 61% (390/639), received C-GSF, while among SGN- cohort, it was 37% (621/1678). Results in this study are based of TriNetX data available as of 1/28/2025. Conclusions: Our study reveals a lower real-world incidence of neutropenia (28%) among Sacituzumab Govitecan recipients compared to clinical trial reports (63%), suggesting potential differences in patient characteristics or treatment practices. Despite this, most patients who developed neutropenia (61%) required G-CSF support, indicating a significant clinical burden. However, the limited prophylactic use of G-CSF (37%) highlights the need for further research to optimize preventive strategies and mitigate neutropenia-related complications in real-world settings.