Sacituzumab Govitecan for the Treatment of Patients with Recurrent or Persistent Cervical Cancer

Inclusion Criteria

• Patients must have radiologically confirmed (i.e., computed axial tomography [CAT] scan and/or MRI) persistent or recurrent histologically confirmed cervical cancer of epithelial origin who have progressed following at least one prior chemotherapy treatment regimen * Must have availability of archival tumor tissue formalin-fixed paraffin-embedded FFPE block for TROP-2 testing * Chemotherapy administered concurrent with primary radiation (i.e., weekly cisplatin) is not counted as a systemic chemotherapeutic regimen for management of persistent or recurrent carcinoma of the cervix
• All patients must have measurable disease. Measurable disease is defined as lesions which can be measured by physical examination or by means of medical imaging techniques. Measurable disease is defined as at least one lesion that can be accurately measured in at least one dimension (longest dimension to be recorded). Each lesion must be >= 20 mm when measured by conventional techniques, including palpation or plain x-ray, or >= 10 mm when measured by spiral CT and/or MRI. Ascites and pleural effusions are not to be considered measurable disease
• Patients must have at least one “target lesion” to be used to assess response on this protocol as defined by Response Evaluation Criteria in Solid Tumors (RECIST) version (v)1.1. Tumors within a previously irradiated field will be designated as “non-target” lesions unless progression is documented or a biopsy is obtained to confirm persistence following completion of radiation therapy
• Patients with measurable recurrent disease of any previous substage (I-IV) are eligible to enrollment
• White blood cells (WBC) greater than or equal to 3,000/ul
• Platelets greater than or equal to 75,000/ul
• Granulocytes greater than or equal to 1500/ul
• Creatinine less than or equal to 2.0 mg/dL
• Bilirubin ≤ 1.5 institutional upper limit of normal
• Aspartate aminotransferase (AST), and alanine aminotransferase (ALT) ≤ 2.5 x institutional upper limit of normal (IULN) or ≤ 5 x IULN if known liver metastases
• Patients must have an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1
• Patients must have signed an approved informed consent
• Patients must be at least 2 weeks beyond prior treatment (chemotherapy, investigational drugs including small molecular inhibitors, endocrine therapy, and/or radiation therapy) or major surgery
• Patients must be at least 2 weeks beyond high dose systemic corticosteroids (however, low dose corticosteroids =< 20 mg prednisone or equivalent daily are permitted)
• Patients must have recovered from all acute toxicities to grade 1 or less from adverse events due to a previously administered agent * Note: Patients with ≤ grade 2 neuropathy or ≤ grade 2 alopecia are an exception to this criterion and may qualify for the study * Note: If patients received major surgery, they must have recovered adequately from the toxicity and/or complications from the intervention prior to starting therapy
• Patients with recurrent disease may have received no more than 2 prior chemotherapies for treatment of their cervical cancer
• Patients may have received prior immunotherapy therapy alone or in combination with chemotherapy. A 4-week washout period is required between prior immunotherapy treatment and first dose of sacituzumab govitecan
• Patients of childbearing potential must have a negative serum pregnancy test within 7 days prior to the study entry and must agree to use protocol-specific method(s) of contraception
• Patients must be at least 18 years of age

Exclusion Criteria

• Patients with a positive serum pregnancy test or women who are breastfeeding
• Patients with known hypersensitivity to the study drug, its metabolites, or formulation excipient
• Patients who require ongoing therapy with or prior use of any prohibited medication(s) such as UGT1A1 inhibitors
• Have other concurrent medical or psychiatric conditions that, in the investigator’s opinion, may be likely to confound study interpretation or prevent completion of study procedures and follow-up examinations
• Any medical condition that, in the investigator’s or sponsor’s opinion, poses an undue risk to the patient’s participation in the study
• Patients with a history of other invasive malignancies, with the exception of non-melanoma skin cancers or carcinoma in situ of the cervix, are excluded if there is any evidence of other malignancy being present within the last 5 years
• Patients with a significant history of cardiac disease within 6 months, i.e., uncontrolled hypertension, unstable angina, uncontrolled congestive heart failure (New York Heart Association [NYHA] classification III-IV) or clinically significant cardiac arrhythmia (other than stable atrial fibrillation) requiring anti-arrhythmia therapy
• Patients with known history of clinically significant active chronic obstructive pulmonary disease (COPD), or other moderate-to-severe chronic respiratory illness present within 6 months
• Patients with any unstable medical issue (including cardiac issues as above, active treatment for symptomatic pulmonary embolism, cerebrovascular accident (CVA), renal or hepatic insufficiency, and active infection/sepsis requiring IV antibiotics)
• Have known active central nervous system (CNS) metastases and/or carcinomatous meningitis. Patients with previously treated brain metastases may participate provided they have stable CNS disease for at least 4 weeks prior to the first dose of study drug and all neurologic symptoms have returned to baseline, have no evidence of new or enlarging brain metastases, and are taking ≤ 20 mg/day of prednisone or its equivalent. All patients with carcinomatous meningitis are excluded regardless of clinical stability
• Patients who have an uncontrolled seizure disorder, or active neurological disease
• Have known history of human immunodeficiency virus (HIV)-1 or 2 (or positive HIV-1/2 antibody) with detectable viral load OR taking medications that may interfere with SN-38 metabolism
• Have active hepatitis B virus (HBV) or hepatitis C virus (HCV). In subjects with a history of HBV or HCV, subjects with a detectable viral load will be excluded
• Known hemorrhagic diathesis or active bleeding disorder
• Patients with Gilbert’s disease
• Presence of bulky disease (defined as any single mass > 7 cm in its greatest dimension). Patients with a mass over 7 cm, but otherwise eligible, may be considered for enrollment after discussion and approval with the study principal investigator (PI)
• Patients with active ≥ grade 2 anorexia, nausea or vomiting, and/or signs of intestinal obstruction
• Prior history of intestinal obstruction within 6 months of initiation of study treatment
• Patients with a history of an anaphylactic reaction to irinotecan or ≥ Grade 3 toxicity to prior irinotecan
• Have previously received topoisomerase I inhibitors