Cabozantinib active, safe for brain metastases in patients with renal cell carcinoma
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Cabozantinib demonstrated intracranial activity and appeared safe among patients with renal cell carcinoma and brain metastases, according to a study in JAMA Oncology.
“Brain metastases in patients with renal cell carcinoma are an unmet medical need, with systemic therapies having little effect,” Toni K. Choueiri, MD, director of the Lank Center for Genitourinary Oncology at Dana-Farber Cancer Institute and Jerome and Nancy Kohlberg chair and professor of medicine at Harvard Medical School, told Healio. “If the lesions can be captured and stabilized by radiation therapy or resected, we may not need cabozantinib [Cabometyx/Cometriq, Exelixis], unless it is already being used for extracranial disease control.”
Investigators sought to assess the clinical activity and safety of cabozantinib among 88 adults (78% men; median age at cabozantinib initiation, 61 years) with metastatic renal cell carcinoma and brain metastases receiving treatment across 15 international institutions in the U.S., Belgium, France and Spain between January 2014 and October 2020. Patients had either progressing brain metastases without concomitant brain-directed local therapy (cohort A; n = 33) or stable or progressing brain metastases treated concomitantly with brain-directed local therapy (cohort B; n = 55).
Median follow-up was 17 months (range, 2-74).
Results showed an intracranial response rate of 55% (95% CI, 36-73) in cohort A and 47% (95% CI, 33-61) in cohort B. For patients in cohort A, the extracranial response rate was 48% (95% CI, 31-66), median time to treatment failure was 8.9 months and median OS was 15 months. Patients in cohort B had an extracranial response rate of 38% (95% CI, 25-52), a median time to treatment failure of 9.7 months and median OS of 16 months.
Researchers observed no unexpected adverse events and no treatment-associated deaths occurred.
“At Dana-Farber Cancer Institute, we continue to lead studies in renal cell carcinoma in hard-to-treat renal cell cancer populations of unmet need such as brain metastases and rare forms of kidney cancer,” Choueiri said. “Patients with kidney cancer who are refractory to therapy is also an example. The data with cabozantinib is intriguing. Because it is retrospective, surgery with or without radiation should be the primary modality for brain metastases. In cases of unsafe location or progression on surgery or radiation, cabozantinib is a reasonable option. An ongoing, prospective study in France, dubbed CABRAMET, will be more definitive.”
For more information:
Toni K. Choueiri, MD, can be reached at Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215; email: toni_choueiri@dfci.harvard.edu.
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