Matthew R Smith1, Christopher J Sweeney2, Paul G Corn2, Dana E Rathkopf2, David C Smith2, Maha Hussain2, Daniel J George2, Celestia S Higano2, Andrea L Harzstark2, A Oliver Sartor2, Nicholas J Vogelzang2, Michael S Gordon2, Johann S de Bono2, Naomi B Haas2, Christopher J Logothetis2, Aymen Elfiky2, Christian Scheffold2, A Douglas Laird2, Frauke Schimmoller2, Ethan M Basch2, Howard I Scher2. 1. Matthew R. Smith, Massachusettes General Hospital; Christopher J. Sweeney, Aymen Elfiky, Dana-Farber Cancer Institute, Boston, MA; Paul G. Corn, Christopher J. Logothetis, MD Anderson Cancer Center, Houston, TX; Dana E. Rathkopf, Howard I. Scher, Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York, NY; David C. Smith, Maha Hussain, University of Michigan, Ann Arbor, MI; Daniel J. George, Duke University Medical Center, Durham; Ethan M. Basch, University of North Carolina, Chapel Hill, NC; Celestia S. Higano, University of Washington, Seattle, WA; Andrea L. Harzstark, University of California San Francisco, San Francisco; Christian Scheffold, A. Douglas Laird, Frauke Schimmoller, Exelixis, South San Francisco, CA; A. Oliver Sartor, Tulane Cancer Center, Tulane University, New Orleans, LA; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Michael S. Gordon, Pinnacle Oncology Hematology, Scottsdale, AZ; Naomi B. Haas, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Johann S. de Bono, Royal Marsden Hospital, Sutton, Surrey, United Kingdom. smith.matthew@mgh.harvard.edu. 2. Matthew R. Smith, Massachusettes General Hospital; Christopher J. Sweeney, Aymen Elfiky, Dana-Farber Cancer Institute, Boston, MA; Paul G. Corn, Christopher J. Logothetis, MD Anderson Cancer Center, Houston, TX; Dana E. Rathkopf, Howard I. Scher, Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York, NY; David C. Smith, Maha Hussain, University of Michigan, Ann Arbor, MI; Daniel J. George, Duke University Medical Center, Durham; Ethan M. Basch, University of North Carolina, Chapel Hill, NC; Celestia S. Higano, University of Washington, Seattle, WA; Andrea L. Harzstark, University of California San Francisco, San Francisco; Christian Scheffold, A. Douglas Laird, Frauke Schimmoller, Exelixis, South San Francisco, CA; A. Oliver Sartor, Tulane Cancer Center, Tulane University, New Orleans, LA; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Michael S. Gordon, Pinnacle Oncology Hematology, Scottsdale, AZ; Naomi B. Haas, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Johann S. de Bono, Royal Marsden Hospital, Sutton, Surrey, United Kingdom.
Abstract
PURPOSE: Cabozantinib (XL184), an oral inhibitor of multiple receptor tyrosine kinases such as MET and VEGFR2, was evaluated in a phase II nonrandomized expansion study in castration-resistant prostate cancer (CRPC). PATIENTS AND METHODS: Patients received open-label cabozantinib at daily starting doses of 100 mg or 40 mg until disease progression or unacceptable toxicity. The primary end point was bone scan response, defined as ≥ 30% reduction in bone scan lesion area. Other efficacy end points included overall survival, pain, analgesic use, and biomarkers. RESULTS: One hundred forty-four patients sequentially enrolled in either a 100-mg (n = 93) or 40-mg (n = 51) study cohort. Ninety-one patients (63%) had a bone scan response, often by week 6. Treatment resulted in clinically meaningful pain relief (57% of patients) and reduction or discontinuation of narcotic analgesics (55% of patients), as well as improvements in measurable soft tissue disease, circulating tumor cells, and bone biomarkers. Improvements in each of these outcomes were observed in both cohorts: bone scan response in 73% and 45%, respectively; reductions in measurable soft tissue disease in 80% and 79%, respectively. Median overall survival was 10.8 months for the entire population. Most common grade 3 or 4 adverse events were fatigue (22%) and hypertension (14%). Fewer dose reductions because of toxicity were required in the 40-mg group. CONCLUSION: The evidence suggests that cabozantinib has clinically meaningful activity in CRPC. Cabozantinib resulted in improvements in bone scans, pain, analgesic use, measurable soft tissue disease, circulating tumor cells, and bone biomarkers. Taken together, these phase II observations warrant further development of cabozantinib in prostate cancer.
PURPOSE:Cabozantinib (XL184), an oral inhibitor of multiple receptor tyrosine kinases such as MET and VEGFR2, was evaluated in a phase II nonrandomized expansion study in castration-resistant prostate cancer (CRPC). PATIENTS AND METHODS: Patients received open-label cabozantinib at daily starting doses of 100 mg or 40 mg until disease progression or unacceptable toxicity. The primary end point was bone scan response, defined as ≥ 30% reduction in bone scan lesion area. Other efficacy end points included overall survival, pain, analgesic use, and biomarkers. RESULTS: One hundred forty-four patients sequentially enrolled in either a 100-mg (n = 93) or 40-mg (n = 51) study cohort. Ninety-one patients (63%) had a bone scan response, often by week 6. Treatment resulted in clinically meaningful pain relief (57% of patients) and reduction or discontinuation of narcotic analgesics (55% of patients), as well as improvements in measurable soft tissue disease, circulating tumor cells, and bone biomarkers. Improvements in each of these outcomes were observed in both cohorts: bone scan response in 73% and 45%, respectively; reductions in measurable soft tissue disease in 80% and 79%, respectively. Median overall survival was 10.8 months for the entire population. Most common grade 3 or 4 adverse events were fatigue (22%) and hypertension (14%). Fewer dose reductions because of toxicity were required in the 40-mg group. CONCLUSION: The evidence suggests that cabozantinib has clinically meaningful activity in CRPC. Cabozantinib resulted in improvements in bone scans, pain, analgesic use, measurable soft tissue disease, circulating tumor cells, and bone biomarkers. Taken together, these phase II observations warrant further development of cabozantinib in prostate cancer.
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