Alessia Mennitto1, Emma Zattarin1, Massimo Di Maio2, Davide Bimbatti3, Ugo De Giorgi4, Sebastiano Buti5, Daniele Santini6, Chiara Casadei4, Mariella Sorarù7, Carlo Messina8, Claudia Mucciarini9, Giuseppe Di Lorenzo10,11, Giandomenico Roviello12, Consuelo Buttigliero13, Marco Stellato6, Pierangela Sepe1, Melanie Claps1, Valentina Guadalupi1, Arianna Ottini1, Sandro Pignata14, Filippo G De Braud1,15, Elena Verzoni1, Giuseppe Procopio1. 1. Department of Medical Oncology, Fondazione Irccs Istituto Nazionale Dei Tumori, Milan, Italy. 2. Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Turin, Italy. 3. Medical Oncology 1 Unit, Department of Oncology, Istituto Oncologico Veneto Iov Irccs, Padua, Italy. 4. Department of Medical Oncology, Istituto Scientifico Romagnolo per Lo Studio E La Cura Dei Tumori (Irst), Irccs, Meldola, Italy. 5. Medical Oncology Unit, University Hospital of Parma, Parma, Italy. 6. Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy. 7. Medical Oncology, Camposampiero Hospital, Camposampiero (Padua), Italy. 8. Department of Medical Oncology, Santa Chiara Hospital, Trento, Italy. 9. Medical Oncology Unit, Ramazzini Hospital, Carpi, Italy. 10. Oncology Unit, Andrea Tortora Hospital, ASL Salerno, Pagani, Italy. 11. Department of Medicine and Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy. 12. Department of Health Sciences, Section of Clinical Pharmacology and Oncology, University of Florence, Florence, Italy. 13. Medical Oncology, San Luigi Gonzaga Hospital, Orbassano, Italy. 14. Department of Urology and Gynecology, Istituto Nazionale Tumori Irccs Fondazione "G. Pascale", Naples, Italy. 15. Oncology and Hemato-Oncology Department, University of Milan, Milan, Italy.
Abstract
BACKGROUND: Cabozantinib improves survival in metastatic renal cell carcinoma (mRCC) after prior antiangiogenics. The best treatment at disease progression (PD) is unknown. Being also a AXL/MET inhibitor, involved in acquired resistance, we hypothesized a prolonged tumor growth control in patients continuing cabozantinib despite PD. RESEARCH DESIGN AND METHODS: This retrospective multicenter study enrolled patients receiving cabozantinib after the first line between 2014 and 2020. We compared patients maintaining cabozantinib after first PD due to clinical benefit and good tolerability with those who changed therapy. The postprogression survival (PPS) of both was our primary endpoint. RESULTS: We analyzed 89 patients: 45 received cabozantinib beyond PD and 44 switched therapy. 40.4%, 31.5%, and 28.1% of patients received 1, 2, or >2 prior treatment, respectively. 84.3% were intermediate-poor International Metastatic Renal Cell Carcinoma Database risk. Patients continuing cabozantinib showed a higher response rate to cabozantinib before PD (46.7% vs 25%, p = 0.03) and were more heavily pretreated. Continuing cabozantinib showed a significantly longer PPS compared with switching therapy (median PPS 16.9 vs 13.2 months, HR 0.66, 95%CI 0.48-0.92, p = 0.011). CONCLUSIONS: We observed longer PPS in patients continuing cabozantinib beyond PD, suggesting that this could be an effective option.
BACKGROUND: Cabozantinib improves survival in metastatic renal cell carcinoma (mRCC) after prior antiangiogenics. The best treatment at disease progression (PD) is unknown. Being also a AXL/MET inhibitor, involved in acquired resistance, we hypothesized a prolonged tumor growth control in patients continuing cabozantinib despite PD. RESEARCH DESIGN AND METHODS: This retrospective multicenter study enrolled patients receiving cabozantinib after the first line between 2014 and 2020. We compared patients maintaining cabozantinib after first PD due to clinical benefit and good tolerability with those who changed therapy. The postprogression survival (PPS) of both was our primary endpoint. RESULTS: We analyzed 89 patients: 45 received cabozantinib beyond PD and 44 switched therapy. 40.4%, 31.5%, and 28.1% of patients received 1, 2, or >2 prior treatment, respectively. 84.3% were intermediate-poor International Metastatic Renal Cell Carcinoma Database risk. Patients continuing cabozantinib showed a higher response rate to cabozantinib before PD (46.7% vs 25%, p = 0.03) and were more heavily pretreated. Continuing cabozantinib showed a significantly longer PPS compared with switching therapy (median PPS 16.9 vs 13.2 months, HR 0.66, 95%CI 0.48-0.92, p = 0.011). CONCLUSIONS: We observed longer PPS in patients continuing cabozantinib beyond PD, suggesting that this could be an effective option.
Authors: Giandomenico Roviello; Elisabetta Gambale; Roberta Giorgione; Daniele Santini; Marco Stellato; Giuseppe Fornarini; Sara Elena Rebuzzi; Umberto Basso; Davide Bimbatti; Laura Doni; Gabriella Nesi; Melissa Bersanelli; Sebastiano Buti; Ugo De Giorgi; Luca Galli; Andrea Sbrana; Raffaele Conca; Claudia Carella; Emanuele Naglieri; Sandro Pignata; Giuseppe Procopio; Lorenzo Antonuzzo Journal: Cancer Med Date: 2022-03-20 Impact factor: 4.711