The COSMIC-021 clinical trial investigated a combination of cabozantinib and atezolizumab in untreated clear-cell renal cell carcinoma (RCC). In this video interview, Dr Monty Pal from the City of Hope Hospital in California discusses the side effects from this combination of drugs.
There were two groups of patients; one on 60 mg of cabozantinib plus the standard dose of atezolizumab, and the other on 40 mg cabozantinib plus atezolizumab. The results were similar between the two doses and the time taken for the cancer to return (progression-free survival) was 15 months for the 60 mg group and 19 months for the 40 mg group. Response rates were around 55-60%. There was very low progressive disease, which is very important to patients. This treatment failed to work in about one in 20 patients.
There were a lot of common mild or moderate side effects that indicate that the immunotherapy is having an affect on the tumour or causing an immune response, or some sort of autoimmune response. These were things like fatigue and itching etc. Then there were the more worrisome side effects that needed prompt and drastic treatment. The most common of these were diarrhoea and hepatitis.
Then there can be some rare and incredibly serious side effects associated with these drugs, such as severe pneumonitis (inflammation of the lungs) or myocarditis (inflammation of the heart). These side effects are starting to be seen more often with increased experience with these drugs.
A new phase 3 study, called CONTACT-03, is now looking at the combination of cabozantinib plus atezolizumab as a second-line treatment.