Real-world data on cabozantinib in previously treated patients with metastatic renal cell carcinoma: Focus on sequences and prognostic factors

M. Santoni, D.Y. Heng, S. Bracarda, G. Procopio, M. Milella, C. Porta, M.R. Matrana, G. Cartenì, S.J. Crabb, U. De Giorgi, U. Basso, C. Masini, F. Calabrò, M.G. Vitale, D. Santini, F. Massari, L. Galli, G. Fornarini, R. Ricotta, S. ButiP. Zucali, O. Caffo, F. Morelli, F. Carrozza, A. Martignetti, A. Gelibter, R. Iacovelli, A. Mosca, F. Atzori, N. Vau, L. Incorvaia, C. Ortega, M. Scarpelli, A. Lopez-Beltran, L. Cheng, V. Paolucci, J. Graham, E. Pierce, S. Scagliarini, P. Sepe, E. Verzoni, S. Merler, M. Rizzo, G. Sorgentoni, A. Conti, F. Piva, A. Cimadamore, R. Montironi, N. Battelli

Research output: Contribution to journalArticle

Abstract

Cabozantinib is approved for the treatment of renal cell carcinoma (RCC). However, prognostic factors are still lacking in this context. The aim of this study was to evaluate prognostic factors in RCC patients treated with second-or third-line cabozantinib. A multicenter retrospective real-world study was conducted, involving 32 worldwide centers. A total of 237 patients with histologically confirmed clear-cell and non-clear-cell RCC who received cabozantinib as second-or third-line therapy for metastatic disease were included. We analyzed overall survival (OS), progression-free survival (PFS) and time-to-strategy failure (TTSF) using Kaplan–Meier curves. Cox proportional models were used at univariate and multivariate analyses.The median PFS and OS of cabozantinib were 7.76 months (95% CI 6.51–10.88) and 11.57 months (95% CI 10.90–not reached (NR)) as second-line and 11.38 months (95% CI 5.79–NR) and NR (95% CI 11.51–NR) as third-line therapy. The median TTSF and OS were 11.57 and 15.52 months with the sequence of cabozantinib–nivolumab and 25.64 months and NR with nivolumab–cabozantinib, respectively. The difference between these two sequences was statistically significant only in good-risk patients. In the second-line setting, hemoglobin (Hb) levels (HR= 2.39; 95% CI 1.24–4.60, p = 0.009) and IMDC (International Metastatic Renal Cell Carcinoma Database Consortium) group (HR = 1.72, 95% CI 1.04–2.87, p = 0.037) were associated with PFS while ECOG-PS (HR = 2.33; 95%CI, 1.16–4.69, p = 0.018) and Hb levels (HR = 3.12; 95%CI 1.18–8.26, p = 0.023) correlated with OS at multivariate analysis, while in the third-line setting, only Hb levels (HR = 2.72; 95%CI 1.04–7.09, p = 0.042) were associated with OS. Results are limited by the retrospective nature of the study.This real-world study provides evidence on the presence of prognostic factors in RCC patients receiving cabozantinib. © 2019 by the authors. Licensee MDPI, Basel, Switzerland.
Original languageEnglish
JournalCancers
DOIs
Publication statusE-pub ahead of print - Dec 30 2019

Keywords

  • Cabozantinib
  • Nivolumab
  • Prognosis
  • Real-world data
  • Renal cell carcinoma
  • Targeted therapy
  • avelumab
  • axitinib
  • cabozantinib
  • everolimus
  • ipilimumab
  • nivolumab
  • pazopanib
  • pembrolizumab
  • sunitinib
  • adult
  • aged
  • Article
  • bone metastasis
  • cancer prognosis
  • cancer risk
  • cancer therapy
  • controlled study
  • drug dose sequence
  • drug response
  • female
  • hemoglobin blood level
  • histopathology
  • human
  • human tissue
  • kidney metastasis
  • lung metastasis
  • lymph node metastasis
  • major clinical study
  • male
  • median survival time
  • molecularly targeted therapy
  • overall survival
  • progression free survival
  • renal cell carcinoma
  • retrospective study

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    Santoni, M., Heng, D. Y., Bracarda, S., Procopio, G., Milella, M., Porta, C., Matrana, M. R., Cartenì, G., Crabb, S. J., De Giorgi, U., Basso, U., Masini, C., Calabrò, F., Vitale, M. G., Santini, D., Massari, F., Galli, L., Fornarini, G., Ricotta, R., ... Battelli, N. (2019). Real-world data on cabozantinib in previously treated patients with metastatic renal cell carcinoma: Focus on sequences and prognostic factors. Cancers. https://doi.org/10.3390/cancers12010084