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Sandy Srinivas, MD


Phase III Trial of Combination Therapy for Metastatic Castration-Resistant Prostate Cancer

By: Joshua D. Madera, MD
Posted: Wednesday, February 21, 2024

The use of combination therapy with cabozantinib and atezolizumab in patients with metastatic castration-resistant prostate cancer who have extrapelvic nodal or visceral disease may improve clinical outcomes over second novel hormonal therapy, according to the results of the phase III CONTACT-02 trial, presented at the 2024 American Society of Clinical Oncology (ASCO) Genitourinary (GU) Cancers Symposium (Abstract 18). Given the unmet medical needs of this patient population and the favorable safety profile, this combination therapy regimen may be a suitable treatment alternative, suggested Neeraj Agarwal, MD, of the Huntsman Cancer Institute at the University of Utah, Salt Lake City, and colleagues.

“The combination therapy of atezolizumab and cabozantinib offers a unique clinically synergistic mechanism of action,” stated ASCO expert Mark T. Fleming, MD, in an ASCO press release. “This potentially expands the arsenal of treatment options for patients.”

A total of 507 patients with metastatic castration-resistant prostate carcinoma were recruited for the study. Patients were randomly assigned to receive combination therapy with cabozantinib plus atezolizumab (n = 253) or the control treatment regimen with abiraterone plus either prednisone or enzalutamide (n = 254). Patients were further stratified based on their history of docetaxel treatment, previous novel hormonal therapy, and the presence of liver metastases.

The study authors reported a 6.3-month and 4.2-month radiographic progression-free survival with the combination of cabozantinib plus atezolizumab therapy and controls, respectively (hazard ratio [HR] = 0.65). An improved rate of radiographic progression–free survival (HR = 0.47) was also observed in patients with liver metastases (6.1 months) compared with those without metastases (2.1 months). In addition, patients treated with cabozantinib plus atezolizumab had an increased objective response rate (13.6%) compared with controls (4.2%). Furthermore, 97% of patients receiving cabozantinib plus atezolizumab therapy and 87% of controls experienced treatment-related adverse events.

Disclosure: For full disclosures of the study authors, visit

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