What factors should be considered when deciding between datopotamab deruxtecan and sacituzumab govitecan for a patient with metastatic breast cancer?

When choosing between Dato-DXd and SG, I consider payload differences, toxicity profiles, and prior therapies. Dato-DXd delivers DXd (an exatecan derivative), while SG delivers SN-38 (active irinotecan metabolite). SG demonstrated an OS benefit in TROPiCS-02 (JCO 2023), whereas Dato-DXd showed a PFS...

At the time of progression, we can consider a TROP2 ADC versus chemotherapy (or clinical trial), though given my concern for resistance to the deruxtecan component after exposure to TDXd, I am more likely to recommend sacituzumab govitecan as my next ADC (though all three ADCs share a similar payloa...

Consideration of underlying comorbid conditions may make one agent preferred over another (i.e., inflammatory GI conditions may have me choose Dato-Dxd, whereas an underlying serious lung condition may have me favor sacituzumab). Dosing schedule and patient preference are also important factors in s...