Cabozantinib may be a good treatment option for patients with bone-metastatic advanced renal cell carcinoma (RCC), according to a trial’s subgroup analysis published in the Journal of Clinical Oncology.1
Bone metastases are found in about one-third of patients with advanced RCC, and are linked to serious morbidity, including skeletal-related events, and a worse prognosis among those who receive targeted therapy.
For this subgroup analysis of the randomized phase 3 METEOR trial (ClinicalTrials.gov Identifier: NCT01865747), researchers evaluated whether cabozantinib, a tyrosine kinase inhibitor of MET, VEGFR, and AXL, yields better efficacy outcomes vs everolimus, an mTOR inhibitor, among patients with bone-metastatic advanced RCC.
Of 658 patients enrolled in METEOR, 77 and 65 patients with bone metastases received cabozantinib and everolimus, respectively. The median progression-free survival (PFS) was 7.4 months with cabozantinib vs 2.7 with everolimus (hazard ratio, 0.33), the median overall survival (OS) was 20.1 months vs 12.1 months, respectively (hazard ratio, 0.54), and the objective response rate (ORR) per independent radiology committee was 17% vs 0%, respectively.
Patients who received cabozantinib were also less likely to have skeletal-related events (23% vs 29% with everolimus).
Cabozantinib was, however, associated with a greater number of grade 3 to 4 adverse events (AEs): 73% of patients who received cabozantinib vs 51% of patients who received everolimus had a grade 3 to 4 AE. The most common grade 3 to 4 AEs noted with cabozantinib were fatigue (16% vs 6% with everolimus) and diarrhea (14% vs 0%); the most common grade 3 to 4 AE noted with everolimus was anemia (14% vs 5% with cabozantinib).
The authors concluded that cabozantinib showed “clinical benefits in PFS, OS, and ORR that are observed irrespective of the presence of bone metastases. On the basis of these outcomes, cabozantinib represents a good treatment option for this difficult-to-treat patient population.”
- Escudier B, Powles T, Motzer RJ, et al. Cabozantinib, a new standard of care for patients with advanced renal cell carcinoma and bone metastases? Subgroup analysis of the METEOR trial. J Clin Oncol. 2018 Jan 8. doi: 10.1200/JCO.2017.74.7352 [Epub ahead of print]