This recent retrospective study included 84 patients with metastatic renal cell carcinoma (RCC) who were treated with cabozantinib after being treated with nivolumab. Most of the patients had poor- or intermediate-risk RCC and all patients received a tyrosine kinase inhibitor (TKI) as first-line therapy, followed by nivolumab in the second- or third-line.
Median progression-free survival with cabozantinib was 11.5 months and the objective response rate was 52%. Stable disease was found in 25.3% of patients, and progressive disease in 22.7%. Overall survival was 17.3 months and patients who received cabozantinib earlier in their course of treatment had a longer overall survival. There were no differences based upon the dose of cabozantinib given to patients.
This study shows that cabozantinib is an effective option for metastatic RCC patients after progression on nivolumab. Earlier initiation of cabozantinib in the course of treatment resulted in an overall survival benefit over a late start of cabozantinib, and the starting dose of cabozantinib did not affect overall survival. With around 50% of patients needing a change in dose of cabozantinib, it is reassuring to know that a starting dose of 40mg/day may be just as effective, more tolerable, and could enable a longer cumulative exposure to the active agent than higher doses.
Read more in Practice Update here