Sponsor: Merck Sharp & Dohme LLC (industry)
Phase: 3
Start date: May 3, 2024
Planned enrollment: 450
Sacituzumab tirumotecan (sac-TMT), also known as SKB264 or MK-2870, is an investigational antibody-drug conjugate (ADC) targeting TROP2, a cell surface glycoprotein overexpressed in various cancers. (prnewswire.com)
Sac-TMT comprises a monoclonal antibody directed against TROP2 linked to a topoisomerase I inhibitor payload. This design facilitates targeted delivery of the cytotoxic agent to TROP2-expressing tumor cells, aiming to enhance antitumor efficacy while minimizing systemic toxicity. (prnewswire.com)
Endometrial and Ovarian Cancers
In the phase 2 KL264-01 trial (NCT04152499), sac-TMT monotherapy was evaluated in patients with previously treated advanced endometrial and ovarian cancers. Preliminary results presented at the 2024 ESMO Congress showed:
Median Duration of Response (DOR): 5.7 months (range, 3.8 to 7.4+)
Ovarian Cancer Cohort (n = 40):
Triple-Negative Breast Cancer (TNBC)
The phase 3 OptiTROP-Breast01 study (NCT05347134) compared sac-TMT to physician's choice of chemotherapy in patients with previously treated locally recurrent or metastatic TNBC. Results indicated:
Median Overall Survival (OS): Not reached (95% CI, 11.2 to NE)
Chemotherapy Arm (n = 133):
Sac-TMT demonstrated a statistically significant improvement in PFS and OS compared to chemotherapy. (ascopubs.org)
In the KL264-01 trial, treatment-related adverse events (TRAEs) occurred in all patients:
Common TRAEs: Anemia (88.6%), decreased white blood cell count (81.8%), decreased neutrophil count (65.9%)
Ovarian Cancer Cohort:
No TRAEs led to death, and there were no reports of drug-related interstitial lung disease or pneumonitis. (onclive.com)
In the OptiTROP-Breast01 study, common grade ≥3 TRAEs in the sac-TMT arm included:
Last updated: Apr 2025
Goal: To determine whether sacituzumab tirumotecan (MK-2870), a TROP2-directed antibody-drug conjugate, improves overall survival compared with treatment of physician’s choice in patients with previously treated (third line or later) advanced/metastatic gastroesophageal adenocarcinoma.
Patients: Adults with histologically or cytologically confirmed unresectable or metastatic gastric, gastroesophageal junction, or esophageal adenocarcinoma, ECOG 0–1, measurable disease by RECIST 1.1, and progression after at least two prior systemic regimens (chemotherapy and/or immunotherapy). HER2 status is unrestricted; HER2-positive patients must have received trastuzumab where appropriate. Key exclusions include significant ocular surface disease that impairs corneal healing, grade ≥2 peripheral neuropathy, active inflammatory bowel disease, uncontrolled cardiovascular/cerebrovascular disease, symptomatic effusions requiring recent drainage, prior TROP2-targeted ADC or topoisomerase I inhibitor–based ADC/chemotherapy, active CNS metastases, active infections, and history/current ILD requiring steroids.
Design: Multicenter, open-label, randomized phase 3 superiority study comparing sacituzumab tirumotecan versus physician’s choice therapy. Stratification includes centrally assessed TROP2 status, among others. Planned enrollment ~450 participants.
Treatments: Experimental: Sacituzumab tirumotecan 4 mg/kg IV on days 1, 15, and 29 of each 42-day cycle, with supportive care and permitted rescue medications. Sacituzumab tirumotecan is a TROP2-targeted antibody-drug conjugate linking an anti-TROP2 antibody to a belotecan-derived topoisomerase I inhibitor via a cleavable linker (average DAR ~7.4). The linker enables extracellular and intracellular release of a membrane-permeable payload, supporting a bystander effect. In phase 3 TNBC, it improved PFS and OS over chemotherapy and showed high objective response rates; early-phase lung cancer data suggest notable activity, with myelosuppression (neutropenia, anemia) as common grade ≥3 toxicities. Comparator: Treatment of physician’s choice with one of trifluridine–tipiracil (oral), irinotecan, paclitaxel, or docetaxel per standard dosing schedules, with supportive care.
Outcomes: Primary: Overall survival. Secondary: PFS by BICR per RECIST 1.1, objective response rate by BICR, duration of response, incidence of adverse events, and treatment discontinuations due to adverse events. Time frames extend up to approximately 25–48 months depending on endpoint.
Burden on patient: Moderate. Participants will require baseline and on-treatment imaging for RECIST assessments, routine labs, and safety monitoring comparable to later-line standard care. The investigational arm involves IV infusions on days 1, 15, and 29 of a 42-day cycle, leading to roughly two to three clinic visits per month; comparator regimens also require regular IV or oral administration with monitoring. A pretreatment tumor sample is required for central TROP2 testing, which may involve retrieving archival tissue or a new biopsy if archival material is inadequate. No intensive pharmacokinetic schedules are specified, and visit frequency aligns with standard oncology practice, but cumulative visit and infusion time, plus potential management of myelosuppression, contribute to a moderate overall burden.
Inclusion Criteria:
* Has a histologically-or cytologically-confirmed diagnosis of advanced, unresectable or metastatic gastric adenocarcinoma, gastroesophageal junction adenocarcinoma, or esophageal adenocarcinoma
* Has measurable disease per Response Evaluation Criteria in Solid Tumors 1.1 (RECIST 1.1) as assessed by the local site investigator/radiology. Lesions situated in a previously-irradiated area are considered measurable if progression has been shown in such lesions.
* Has received, and progressed on, at least 2 prior chemotherapy and/or immunotherapy regimens for advanced, unresectable or metastatic gastroesophageal adenocarcinoma.
* Participants are eligible regardless of human epidermal growth factor receptor-2 (HER2) status. Participants who are HER2+ must have previously received trastuzumab where available/appropriate
* Has adequate organ function
* Has provided tumor tissue sample for determination of trophoblast cell-surface antigen 2 (TROP2) status by the central laboratory before randomization for stratification
* Participants who have AEs due to previous anticancer therapies must have recovered to Grade ≤1 or baseline (except for alopecia and vitiligo). Participants with endocrine related AEs who are adequately treated with hormone replacement therapy are eligible
* Has measurable disease per Response Evaluation Criteria In Solid Tumors (RECIST) 1.1 as assessed by the local site investigator/radiology
* Has Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 within 3 days before randomization
* Has ability to swallow oral medication for those who may receive trifluridine-tipiracil
* Human immunodeficiency virus (HIV) infected participants must have well-controlled HIV on antiretroviral therapy (ART)
* Hepatitis B surface antigen (HBsAg) positive participants are eligible if they have received hepatitis B virus (HBV) antiviral therapy and have undetectable HBV viral load
* Participants with a history of hepatitis C virus (HCV) infection are eligible if HCV viral load is undetectable
Exclusion Criteria:
* Has a history of documented severe dry eye syndrome, severe Meibomian gland disease and/or blepharitis, or severe corneal disease that prevents/delays corneal healing
* Has Grade ≥2 peripheral neuropathy
* Has active inflammatory bowel disease requiring immunosuppressive medication or previous history of inflammatory bowel disease (e.g., Crohn's disease, ulcerative colitis, or chronic diarrhea)
* Has uncontrolled, significant cardiovascular disease or cerebrovascular disease, including New York Heart Association Class III or IV congestive heart failure, unstable angina, myocardial infarction, uncontrolled symptomatic arrhythmia, prolongation of corrected QT interval (QTcF) to \>480 ms, and/or other serious cardiovascular and cerebrovascular diseases within 6 months before the first dose of study intervention
* Has accumulation of pleural, ascitic, or pericardial fluid requiring drainage or diuretic drugs within 2 weeks before the first dose of study intervention
* Has received prior treatment with a trophoblast antigen 2(TROP2) targeted antibody-drug conjugate (ADC), a topoisomerase 1 inhibitor based, and/or a topoisomerase 1 inhibitor-based chemotherapy.
* Has received prior systemic anticancer therapy within 2 weeks before the first dose of study intervention
* Has received prior radiotherapy within 2 weeks before the first dose of study intervention, has radiation-related toxicities, requiring corticosteroids, and/or has had radiation pneumonitis
* Has received a live or live-attenuated vaccine within 30 days before the first dose of study intervention
* Is currently receiving a strong and/or moderate inducer/inhibitor of cytochrome P450 3A4 (CYP3A4) that cannot be discontinued for the duration of treatment with study intervention. The required washout period before starting study intervention is 2 weeks
* Has received an investigational agent or has used an investigational device within 4 weeks before the first dose of study intervention
* Has a known additional malignancy that is progressing or has required active treatment within the past 3 years
* Has known active central nervous system (CNS) metastases and/or carcinomatous meningitis
* Has an active infection requiring systemic therapy
* HIV infected participants with a history of Kaposi's sarcoma and/or Multicentric Castlemans's Disease
* Has concurrent active hepatitis B (defined as hepatitis B surface antigen (HBsAg) positive and/or detectable HBV deoxyribonucleic acid (DNA)) and Hepatitis C virus (HCV) defined as anti-HCV antibody (Ab) positive and detectable HCV ribonucleic acid (RNA)) infection
* Has had major surgery or significant traumatic injury within 4 weeks before the first dose of study intervention. Anticipation of the need for major surgery during the course of treatment with study intervention is also exclusionary
* Has severe hypersensitivity (Grades \>=3) to the study interventions, any of their excipients, and/or to another biologic therapy
* Has a history of (noninfectious) pneumonitis/ interstitial lung disease (ILD) that required steroids or has current pneumonitis/ILD
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