‘Smart bomb’ drug better than chemo for aggressive breast cancer

Good news for a grave concern.

Researchers believe a groundbreaking new drug can offer hope to those diagnosed with this deadly breast cancer, creating a new standard of care and improved survival rates.

A clinical trial of a “smart bomb” cancer drug known as Trodelvy, an antibody-drug conjugate, has shown that the treatment is significantly better than chemotherapy for patients with newly diagnosed, advanced triple-negative breast cancer who aren’t candidates for immunotherapy. 

“The trial delivers compelling evidence that Trodelvy is clinically superior to chemotherapy as a first-line treatment in patients with newly diagnosed metastatic triple-negative breast cancer,” said Dr. Francisco J. Esteva, MD, chief of the Division of Hematology & Medical Oncology, Lenox Hill Hospital, who was not involved with the study.

Breast cancer is the most common cancer among US women after skin cancer. About 1 in 8 women will be diagnosed with breast cancer in their lifetime. 

Triple-negative breast cancer, or TNBC, is a more aggressive type of breast cancer that does not have any of the three common “receptors” in the cells, which means it doesn’t respond to the hormonal therapies that are typically used to fight the disease. 

About 15% of all breast cancers are TNBC.

In about 42% of TNBC cases, the cancer recurs within five years, which is roughly three times higher than other types of breast cancer.

According to this latest study, published in the New England Journal of Medicine, only around 15% of TNBC patients with metastatic disease survive 5 years after diagnosis.

In the trial, patients with locally advanced, inoperable, or metastatic triple-negative breast cancer who had not received previous systemic therapy were given either Trodelvy or chemotherapy.

Trodelvy extended progression-free survival to 9.7 months, compared to just 6.9 months with chemotherapy.

According to Esteva, Trodelvy works by targeting and binding to surface proteins in tumors.

“Upon binding to the cancer cell, Trodelvy is internalized and released intracellularly, maximizing tumor cell kill while sparing most healthy tissue. This targeted action underpins its ‘smart bomb’ designation and contributes to its favorable efficacy and safety profile,” he said.

The study found that Trodelvy induced more durable responses compared to chemotherapy — 12.2 months versus 7.2 months.

“These results support Trodelvy as a potential new standard of care for advanced TNBC, offering meaningful therapeutic improvement over chemotherapy alone,” Esteva added.

During the trial, only 4% of patients on Trodelvy discontinued due to toxicity — compared to 12% with chemo.

Experts like Esteva say this enhances the real-world applicability of the drug.

“Trodelvy demonstrated consistent efficacy across all predefined subgroups, including those with poor prognostic factors such as liver metastases and early relapse,” he said.

Esteva notes that despite its modest efficacy and significant toxicity, chemotherapy has long been the standard treatment for TNBC.

“Agents like Trodelvy are vital because they provide more sustained disease control, avoid classic chemotherapy toxicities such as peripheral neuropathy, maintain or improve patient quality of life, and, by improving early disease stabilization, enable eligibility for second-line therapies,” he said.

He calls the development and efficacy of treatments like Trodelvy a “paradigm shift in care” and is hopeful that if approved, the drug could both extend and save lives.

“Trodelvy could save lives down the line. It has already demonstrated overall survival benefit in later-line TNBC, and earlier use may further enhance outcomes.”

Trodelvy supports patient survival in three key ways:

• This treatment delays disease progression at a critical juncture.
• Improves the likelihood of receiving subsequent therapies—a key determinant of survival.
• Reduces attrition due to toxicity, preserving function and systemic reserve.

“By incorporating Trodelvy earlier in the treatment course, we are positioning patients to live longer and live better—a meaningful advancement in a historically underserved patient population.”

Previous research found that, when used in combination with Merck’s immunotherapy Keytruda, Trodelvy decreased the risk of TNBC progressing by 35%.