Medical Oncologist
Medicines
Sacituzumab govitecan side effects: the complete list and timeline
Sacituzumab govitecan carries a chemotherapy drug to breast cancer cells, so its side effects resemble strong chemotherapy. A low white cell count and loose motions need the closest watching. This page lists the common side effects, when they usually appear, and how your team helps you manage them safely.
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Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed September 2026, next review due September 2027
On this page
- What side effects does sacituzumab govitecan cause, and when?
- The side effects most people notice
- When side effects usually appear
- The vocabulary, in plain language
- What to expect honestly
- Looking after yourself between doses
- What happens when side effects are significant
- What people assume about these side effects
- Common questions about sacituzumab govitecan side effects
The short answer
What side effects does sacituzumab govitecan cause, and when?
Sacituzumab govitecan is an antibody-drug conjugate. An antibody carries a chemotherapy drug, called SN-38, to breast cancer cells that carry a protein named Trop-2. Because the chemotherapy part is released inside and around those cells, the side effects look much like strong chemotherapy. The two that matter most are a low white cell count, which raises the risk of infection, and loose motions, which can become severe if they are not treated early. Both carry a boxed warning on the medicine's official label. Feeling sick, vomiting, tiredness, hair loss, constipation, a low haemoglobin and loss of appetite are also common. Most side effects follow a pattern. Reactions to the drip happen during or soon after the infusion. Feeling sick tends to appear in the first two or three days after a dose. Loose motions can start within hours or several days later. White cell counts usually fall in the week or so after doses, so blood tests are done before every infusion. Hair loss often begins a few weeks into treatment. Tiredness tends to build up over the cycles. Knowing this timeline helps you spot problems early, and most side effects can be managed with medicines, dose delays or dose reductions.
Two side effects need quick action
A fever or signs of infection, and loose motions that do not settle with the medicine you were given, should be reported the same day.
Preventive medicines help
Anti-sickness medicines and medicines to reduce drip reactions are given before each dose.
Doses can be adjusted
Your team may delay a dose or lower it so you can continue safely.
This page gives general information only. Follow the advice of your own oncology team.The main side effects
The side effects most people notice
Not everyone gets all of these, and severity varies a great deal between people.
Low white cell count
Very common. It lowers your ability to fight infection. Blood tests before each dose check your count, and growth factor injections may be used if it drops too far.
A fever is an emergency during treatment.Loose motions
Common, and occasionally severe. Early loose motions with cramps and sweating can happen within a day of the drip. Later loose motions are treated with anti-diarrhoea tablets and fluids.
Feeling sick and vomiting
Common in the first days after each dose. Anti-sickness medicines are given before the drip and often taken at home for a few days.
Other common effects
Tiredness, hair loss, constipation, a low haemoglobin, loss of appetite and a rash can occur.
Get help urgently for
- A temperature, chills or shivering
- Loose motions with dizziness or little urine
- Swelling of the face or trouble breathing during the drip
Timeline
When side effects usually appear
When
What to watch for
During the drip and the hour after
Flushing, itching, chills, breathlessness or a rash, which are infusion reactions
First day after a dose
Early loose motions with cramps, sweating, watery eyes or a runny nose
First two or three days
Feeling sick, vomiting, reduced appetite and tiredness
About a week or more after doses
Falling white cell count, infection risk and later loose motions
Over weeks and months
Hair loss, building tiredness and a low haemoglobin
Words you will hear
The vocabulary, in plain language
- Antibody-drug conjugate
- An antibody joined to a chemotherapy drug, so the drug is carried to cancer cells.
- Trop-2
- A protein on the surface of most breast cancer cells that the antibody locks on to.
- Neutrophils
- White cells that fight bacterial infection. Low levels raise infection risk.
- Growth factor injection
- An injection that helps the bone marrow make white cells faster.
- Dose reduction
- Lowering the amount given so side effects become easier to manage.
- Infusion reaction
- A reaction to the drip itself, usually during or soon after it.
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Have a question about your situation?
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Being straight with you
What to expect honestly
Sacituzumab govitecan is not a gentle treatment. Many people need at least one delay or dose change, and that is a normal part of using it safely.
Side effects are real but often manageable
In studies, most people had some side effects, yet relatively few stopped treatment because of them, largely thanks to early support.
A lower dose does not mean failure
Reducing the dose is a planned step to keep you on treatment, not a sign that it has stopped working.
Some people are more sensitive
People who inherit a slower version of an enzyme called UGT1A1 break down the drug more slowly and may have more severe low counts and loose motions.
What this page cannot tell you
It cannot predict which side effects you will get or how strong they will be. Your team will review you before every dose.
At home
Looking after yourself between doses
Much of the work of managing side effects happens at home, in the days between infusions. Simple habits make a real difference.
Check your temperature
Keep a working thermometer at home. If you feel hot, shivery or unwell, check your temperature and follow the fever advice your team gave you, without waiting until morning.
Keep the anti-diarrhoea plan handy
Know exactly when to start the tablets you were given, drink plenty of fluids such as oral rehydration solution, and tell the team if loose motions carry on despite the medicine.
Eat little and often
Small, bland meals are easier when you feel sick. Wash fruit and vegetables well and avoid undercooked food while counts are low.
Keep a side effect diary
Note the day each problem started, how bad it was and what helped. This helps your team decide on dose changes.
How your team responds
What happens when side effects are significant
Your oncology team has a set of standard steps for the main side effects. These are based on the official prescribing information and on experience with similar chemotherapy.
Delaying a dose
If your white cell count is too low on the day of treatment, the dose is usually held until it recovers. A missed day-eight dose is not always made up later.
Lowering the dose
After a severe episode, later doses may be given at a reduced level. Most people can have up to two reductions before the treatment is reconsidered.
Adding support
Growth factor injections, stronger anti-sickness medicines or medicine for early cramping loose motions may be added to future cycles.
Commonly believed
What people assume about these side effects
Because it is targeted, it is milder than chemotherapy.
It carries a chemotherapy drug, so its side effects are similar to strong chemotherapy.
Loose motions are just an inconvenience.
They can cause dehydration quickly and should be treated early.
Having side effects means the drug is working better.
Side effects do not show how well the treatment is controlling the cancer.
A fever can wait until the next appointment.
A fever during treatment needs same-day medical advice.
Questions we are asked
Common questions about sacituzumab govitecan side effects
Will I lose my hair?
Hair loss is common with sacituzumab govitecan, affecting a large share of people in studies. It usually starts a few weeks after the first dose and may be patchy or complete. Hair generally grows back after treatment ends. A soft cap, scarf or wig can help, and your nurse can advise on gentle scalp care.
How soon after the drip might I feel unwell?
Infusion reactions happen during the drip or soon after, which is why you are watched in the day care unit. Feeling sick usually starts within a day or two. Early loose motions with cramps can come on within hours, while later loose motions and low counts appear several days afterwards.
What counts as a fever?
Your team will tell you the exact temperature at which to seek help. As a general guide, a raised temperature, shivering or feeling suddenly unwell during treatment should be reported straight away. Do not take paracetamol to bring it down before speaking to someone, as it can hide a fever.
Can I prevent loose motions?
You cannot always prevent them, but acting quickly stops them becoming severe. Start the anti-diarrhoea tablets as soon as you were told to, drink plenty of fluids, and eat bland, low-fibre food for a day or two. If cramps and sweating come on during or just after the drip, tell the nurse.
Does it cause nerve damage?
Tingling and numbness in the hands and feet are not among its main side effects, unlike some other chemotherapy drugs used in breast cancer. Some people already have nerve damage from earlier treatment, and that may continue. Tell your team about any new or worsening tingling.
Will I be too tired to work?
Tiredness is common and tends to build over time. Some people keep working with adjusted hours, while others need time off, especially around infusion days. Gentle activity, rest when needed and treating a low haemoglobin can help. Talk to your team if tiredness stops you coping with daily life.
Are the side effects permanent?
Most side effects improve once treatment stops or the dose is lowered. Blood counts recover, loose motions settle and hair usually regrows. Tiredness can take longer to lift. Your team will check you regularly, and they can explain which effects might linger in your own situation.
Should I take supplements to reduce side effects?
Please check with your oncology team first. Some herbal products and supplements can change how the body handles this medicine or affect the liver. Oral rehydration solution and the medicines your team prescribes are the safest starting point for most side effects.
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Sources
- National Cancer Institute — Sacituzumab govitecan-hziy
- Macmillan Cancer Support — Sacituzumab govitecan (Trodelvy)
- European Medicines Agency — Trodelvy product information
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.