Cabometyx first line for renal cell carcinoma – pro
Cabozantinib, an inhibitor of tyrosine kinases including MET, vascular endothelial growth factor receptors, and AXL, increased progression-free survival (PFS), overall survival (OS), and objective response rate (ORR) in patients with advanced renal cell carcinoma (RCC) after previous vascular endothelial growth factor receptortargeted therapy in the phase III METEOR trial.Cabozantinib is currently the only drug that has improved PFS, objective RR and OS for patients with mRCC in a pivotal phase III trial after one or more prior VEGFR TKIs. Most recently, cabozantinib has been tested in the first-line setting for a subgroup of patients with mRCC, providing apparently exciting results, which in our opinion should be carefully considered before being translated into clinical practice. Cabozantinib improved PFS and RR compared with sunitinib in the randomized phase II CABOSUN trial, enrolling treatment-naive patients with mRCC of International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) intermediate- and poor-risk groups. NCCN recommends it in first line for poor risk disese
As such, treatment in the first line is supported by the literature.
NCCN, Kid-3 2018
B. Escudier et al, Cabozantinib, a New Standard of Care for Patients With Advanced Renal Cell Carcinoma and Bone Metastases? Subgroup Analysis of the METEOR TrialJournal of Clinical Oncology 36, no. 8 (March 2018) 765-772.
Choueiri TK, Halabi S, Sanford BL, et al. Cabozantinib versus sunitinib as initial targeted therapy for patients with metastatic renal cell carcinoma of poor or intermediate risk: the alliance A031203 CABOSUN trial. J Clin Oncol 2017; 35(6): 591597.
Buti S, Bersanelli M. Is cabozantinib really better than sunitinib as first-line treatment of metastatic renal cell carcinoma? J Clin Oncol 2017; 35(16): 18581859