This episode is sponsored by Gilead Sciences. Gilead had no involvement or input in the podcast content. Gilead is working to transform how cancer is treated. We are innovating with next-generation therapies, combinations, and technologies to deliver improved outcomes for people with cancer. From antibody drug conjugates and small molecules to cell therapy-based approaches, our portfolio and pipeline assets are creating new possibilities for people with cancer.
For people living with metastatic triple-negative breast cancer, treatment can sometimes feel like a game of chess: make a move, see what happens, and then figure out the next move.But as new treatments move earlier in the treatment sequence, the goal is becoming bigger than simply finding the next available therapy. It is about strategically using the treatments available today to give patients more time before their cancer progresses, preserve options for what comes next, and help them maintain the best possible quality of life along the way.
On this episode of The Patient From Hell, host Samira Daswani speaks with Dr. Alissa Huston, a breast medical oncologist and Co-Medical Director of the Pluta Integrative Oncology & Wellness Center at the University of Rochester, about the evolving treatment landscape for metastatic triple-negative breast cancer and the results of the ASCENT-03 clinical trial.
This is a Gilead Sciences-sponsored episode. The discussion focuses on the science behind the trial, what the results may mean for patients, how oncologists think about treatment sequencing and toxicity, and why communication between patients and their care teams remains essential.
Episode Highlights
-
ASCENT-03 and first-line treatment: Dr. Huston explains how the trial evaluated an antibody-drug conjugate as an initial treatment option for people with metastatic triple-negative breast cancer who were not eligible for immunotherapy.
-
What progression-free survival actually means: For patients, PFS can be a confusing clinical-trial endpoint. Dr. Huston explains why more time before cancer progresses can be meaningful, particularly when patients are able to remain on treatment.
-
Treatment sequencing matters: Moving an effective treatment earlier can potentially provide longer disease control while preserving additional treatment options for later lines.
-
Managing treatment toxicity: Neutropenia, neuropathy, nausea, and fatigue can affect treatment decisions. Dr. Huston explains why dose adjustments are sometimes an important part of keeping patients safely on treatment rather than a sign that treatment is failing.
-
Why patients should speak up about side effects: Reporting symptoms early can give the care team more opportunities to intervene, manage side effects, and prevent them from becoming more serious.
-
Integrative oncology: Alongside standard cancer treatment, evidence-based approaches such as acupuncture, nutrition, physical activity, and other supportive strategies can help address symptoms and improve quality of life.
About Dr. Alissa Huston
Dr. Alissa Huston, MD, is a Professor of Medicine at the University of Rochester's Wilmot Cancer Institute, where her clinical focus is breast cancer. She is also the Co-Medical Director of the Pluta Integrative Oncology & Wellness Center, where she works to integrate evidence-based supportive and wellness strategies into conventional cancer care.
Dr. Huston has spent approximately two decades caring for patients with breast cancer and has watched the field evolve from a much more chemotherapy-centered approach into one increasingly shaped by molecular testing, immunotherapy, targeted treatments, and more personalized treatment strategies.
Her work in integrative oncology focuses on helping patients manage treatment-related symptoms while remaining grounded in evidence-based cancer care. She is also active in the Society for Integrative Oncology and research surrounding the use of integrative approaches in cancer treatment and symptom management.
ASCENT-03: A New Option in First-Line Metastatic Triple-Negative Breast Cancer
Metastatic triple-negative breast cancer has historically offered fewer treatment targets than some other breast cancer subtypes.
For patients whose tumors do not have sufficient PD-L1 expression for first-line immunotherapy, or who otherwise cannot receive PD-1 or PD-L1 inhibitor-based treatment, chemotherapy has traditionally been an important part of initial treatment.
ASCENT-03 asked whether an antibody-drug conjugate could move into this first-line setting and provide a better option than standard chemotherapy.
The phase 3 randomized trial enrolled 558 patients with previously untreated, unresectable locally advanced or metastatic triple-negative breast cancer who were not candidates for PD-1 or PD-L1 inhibitor therapy. Patients were randomized to receive either sacituzumab govitecan or chemotherapy selected by their physicians.
The study found a statistically significant improvement in progression-free survival:
9.7 months with sacituzumab govitecan vs. 6.9 months with chemotherapy
The hazard ratio for disease progression or death was 0.62, meaning the study showed a significant reduction in the risk of progression or death with the antibody-drug conjugate compared with the chemotherapy control group.
The median duration of response was also longer, at 12.2 months versus 7.2 months, while rates of treatment discontinuation because of adverse events were 4% and 12%, respectively. Grade 3 or higher adverse events occurred in 66% of patients receiving sacituzumab govitecan and 62% receiving chemotherapy.
Why Progression-Free Survival Matters to Patients
Clinical-trial terminology can be difficult to translate into what treatment actually means in someone's daily life.
As Dr. Huston explains, progression-free survival refers to the amount of time a patient lives without their cancer worsening. That can mean more time before another treatment is needed, but it can also mean more time on a treatment that is working and allowing someone to continue living their life.
That distinction matters in metastatic cancer, where treatment is often about managing the disease over time rather than expecting a single treatment to be the final answer.
The goal becomes strategic: use the treatments available today in a way that maximizes the amount of time a patient can benefit from them while preserving additional options for later.
The Importance of Treatment Sequencing
One of the most interesting patient-centered ideas in the conversation is treatment sequencing.
A treatment moving earlier in the treatment algorithm does not necessarily mean the other treatments disappear. Instead, it can change the order in which those tools are used.
Dr. Huston describes it as almost "reverse order" treatment: use an effective therapy earlier, potentially gain a longer period before progression, and then move to other available treatments when they are needed.
That is why progression-free survival is only one part of the conversation. Oncologists also have to think about what treatments remain available after progression, how long patients can stay on each treatment, and how the side effects of one therapy might affect the options that come later.
Toxicity Is Part of the Treatment Strategy
A treatment can be effective and still be difficult.
In ASCENT-03, one of the most prominent serious adverse events was neutropenia, a reduction in infection-fighting neutrophils. In the trial, grade 3 or higher neutropenia occurred in 43% of patients receiving sacituzumab govitecan compared with 41% receiving chemotherapy.
Dr. Huston explains why oncologists often try to get ahead of this risk using supportive medications that help stimulate white blood cell production.
She also emphasizes that treatment-related toxicity can change over time. Some side effects may emerge or become more significant after a patient has been on therapy for months, including neuropathy and fatigue.
That is where communication becomes critical.
Why a Dose Reduction Isn't Necessarily Bad News
Patients can understandably become frightened when their oncologist suggests reducing the dose of a treatment. It can feel like reducing the dose means reducing the effectiveness.
Dr. Huston offers a different perspective.
Dose modifications are built into the way treatments are studied and administered. When clinical trials identify particular levels of toxicity, those studies help establish when treatment should be adjusted. A dose reduction can therefore be part of the evidence-based strategy for keeping someone on treatment safely rather than simply continuing until toxicity becomes dangerous.
This is especially important with cumulative toxicities such as neuropathy. Severe neuropathy can potentially interfere with a patient's ability to receive other treatments later, making early management an important part of long-term planning.
The takeaway is simple: tell your oncology team what you are experiencing, even when you're worried about what they might do in response.
Integrative Oncology: Supporting the Whole Patient
Dr. Huston's work extends beyond breast oncology.
As Co-Medical Director of the Pluta Integrative Oncology & Wellness Center, she works to incorporate evidence-based supportive care into conventional cancer treatment. She defines integrative oncology as an approach that can include lifestyle modifications, mind-body practices, and complementary approaches that are supported by evidence and used alongside standard cancer therapy.
During the episode, she discusses approaches such as acupuncture, nutrition, physical activity, acupressure, and ginger as examples of tools that may help manage specific treatment-related symptoms.
The distinction is important: integrative oncology is not about replacing cancer treatment. It is about finding evidence-based ways to support patients alongside their cancer treatment.
A More Strategic Way to Think About Cancer Treatment
Samira and Dr. Huston return to a chess analogy during the conversation.
Cancer treatment can involve a series of decisions: one treatment, followed by another, followed by another. The objective is to use each available tool strategically, looking not only at whether a treatment works, but also at how long it may work, what side effects it creates, and what options remain afterward.
For Dr. Huston, ASCENT-03 is an example of that evolution. An antibody-drug conjugate that was previously used later in the treatment sequence is now being studied and used earlier for a specific group of patients, potentially changing how the overall treatment sequence is constructed.
And as molecular testing continues to identify additional targets, the treatment "board" may continue to expand.
What Dr. Huston Wants Patients to Know
When asked what she would tell a patient and their family after a new diagnosis of metastatic triple-negative breast cancer, Dr. Huston comes back to two things: know your goals and establish open communication with your oncology team.
Patients may prioritize different things. Some may place the greatest importance on maximizing time, while others may prioritize quality of life or minimizing certain side effects. Understanding those goals helps clinicians discuss which treatment options may best fit an individual patient.
Just as important, patients need to feel comfortable telling their care team how they are actually doing on treatment.
The treatment plan is not static. It can change as the cancer responds, as side effects develop, and as new treatment options become available.
Pull Quote
"There are so many options. And hopefully ... patients will have that takeaway because that's what we're seeing every day."
— Dr. Alissa Huston
A Note on the Trial and Regulatory Timing
The ASCENT-03 results were published in the New England Journal of Medicine in October 2025. The FDA subsequently approved sacituzumab govitecan-hziy as a single-agent first-line treatment on June 24, 2026, for adults with unresectable locally advanced or metastatic triple-negative breast cancer who are not candidates for PD-1 or PD-L1 inhibitor-based therapy.
This episode discusses the clinical data and what it may mean for patients and treatment sequencing. Treatment decisions should always be based on an individual's specific diagnosis, pathology, prior treatment history, and eligibility for available therapies.
Resources Mentioned
University of Rochester Medicine — Alissa Huston, MD
Learn more about Dr. Huston's work in breast oncology and integrative oncology.
Pluta Integrative Oncology & Wellness Center
An evidence-based integrative oncology program within the Wilmot Cancer Institute at the University of Rochester.
ASCENT-03 Clinical Trial
Phase 3 research evaluating first-line sacituzumab govitecan versus chemotherapy in patients with advanced triple-negative breast cancer who were not candidates for PD-1 or PD-L1 inhibitor therapy.
Listen to The Patient From Hell
The Patient From Hell is hosted by Samira Daswani, cancer survivor, entrepreneur, and founder of Manta Cares. Through candid conversations with patients, physicians, researchers, and healthcare leaders, the show explores the realities of cancer care while empowering patients with practical, evidence-based information.
Listen and watch through Manta Cares, YouTube, Spotify, and Apple Podcasts.
Sponsorship Disclosure
This episode of The Patient From Hell is sponsored by Gilead Sciences. Gilead had no involvement or input in the podcast content.
Disclaimer
This podcast, accompanying article, show notes, and newsletter are intended for general informational and educational purposes only and do not constitute medical advice, diagnosis, treatment, or professional healthcare services. No doctor-patient relationship is formed through this content. Always consult a qualified healthcare professional regarding your individual diagnosis, treatment options, and medical decisions. The opinions expressed by guests are their own and do not necessarily represent the views of organizations with which they are affiliated or of Manta Cares or its sponsors.
