Background
Chinese expert consensus on the clinical application of TROP2-targeted antibody-drug conjugates (ADCs) in NSCLC. Reviews 3 agents: sacituzumab tirumotecan, datopotamab deruxtecan, sacituzumab govitecan. Emphasis on efficacy, safety, and toxicity management.
Interventions and follow up
Design: Expert consensus statement on TROP2-targeted ADCs in NSCLC
Primary endpoint: Consensus on patient selection, sequencing, and toxicity management
mFollow up: Not applicable
Primary endpoint: Consensus on patient selection, sequencing, and toxicity management
mFollow up: Not applicable
Results
Response rates: 30–50% across agents
Survival: OS benefit demonstrated in some cohorts
Durability: durable responses in treatment-refractory NSCLC
Survival: OS benefit demonstrated in some cohorts
Durability: durable responses in treatment-refractory NSCLC
Adverse events
Mucosal: mucositis 20–40% (grade 3+), manageable with prophylaxis
Hematologic: myelosuppression (anemia, neutropenia) 15–25% (grade 3+)
GI: diarrhea, nausea 10–20% (grade 3+)
Management: proactive anti-diarrheal prophylaxis, oral care protocols, G-CSF support when indicated
Hematologic: myelosuppression (anemia, neutropenia) 15–25% (grade 3+)
GI: diarrhea, nausea 10–20% (grade 3+)
Management: proactive anti-diarrheal prophylaxis, oral care protocols, G-CSF support when indicated
Conclusions
TROP2 ADCs show substantial antitumor activity and survival benefit; standardized clinical use and safety management protocols are essential for optimal outcomes. Toxicity is manageable with proactive strategies, and benefit-risk favors use in appropriate patients.
Key Limitations
Consensus statement, not a primary trial — no new comparative data; recommendations reflect expert opinion. Efficacy figures are aggregated across heterogeneous trials, lines of therapy, and agents. Regional (China-focused) perspective may not generalize to all regulatory settings. Optimal sequencing and biomarker selection (TROP2 expression) remain undefined.
Clinical Context
Datopotamab deruxtecan is FDA-approved in EGFR-mutant NSCLC after prior therapy; sacituzumab govitecan and sacituzumab tirumotecan remain investigational in NSCLC. ESMO and ASCO have not issued dedicated TROP2-ADC NSCLC guidance. This consensus offers practical Chinese-context guidance on selection and toxicity management ahead of formal guidelines.