GU Cancers Symposium: Cabozantinib vs. Sunitinib in Untreated Patients With Advanced Kidney Cancer
For patients with untreated advanced renal cell carcinoma of intermediate or poor risk, initial systemic therapy with cabozantinib resulted in improved outcomes versus sunitinib in the phase II Alliance A031203 CABOSUN trial. Results of the study, led by Daniel J. George, MD, of the Duke Cancer Institute, Durham, North Carolina, were revealed at the 2018 Genitourinary Cancers Symposium in San Francisco (Abstract 582).
A total of 157 patients were randomized to receive 60 mg of cabozantinib or 50 mg of sunitinib, stratified by the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) risk group and the presence of bone metastases. The subgroup analyses are based on stratification factors, age, sex, baseline Eastern Cooperative Oncology Group (ECOG) status, and mesenchymal-epithelial transition factor (MET) tumor expression by immunohistochemistry.
Hazard ratios for progression-free survival per independent radiology review committee favored cabozantinib across all subgroups analyzed, with 0.52 and 0.31 reported for the intermediate-risk and poor-risk groups, respectively. Subgroups with poor prognostic characteristics (poor risk, ECOG status 1 or 2, presence of bone metastases) had shorter median progression-free survival with both cabozantinib and sunitinib. Additionally, odds ratios for objective response rate also favored cabozantinib, with the highest rate observed in the MET-positive subgroup (34% with cabozantinib vs. 10% with sunitinib).