FDA Approves Cabozantinib for First-Line Treatment of Advanced Renal Cell Carcinoma

On December 19, 2017, the U.S. Food and Drug Administration (FDA) granted regular approval to cabozantinib (Cabometyx) for treatment of patients with advanced renal cell carcinoma (RCC).

The FDA previously approved cabozantinib in 2016 for treatment of patients with advanced RCC who have received prior antiangiogenic therapy. Today’s approval provides for treatment in the first-line setting.

CABOSUN Trial

This approval was based on data from the CABOSUN trial, a randomized, open-label phase II multicenter study in 157 patients with intermediate- and poor-risk previously untreated RCC. Patients received cabozantinib (n = 79) 60 mg orally daily or sunitinib (Sutent) (n = 78) 50 mg orally daily (4 weeks on treatment followed by 2 weeks off) until disease progression or unacceptable toxicity. Estimated median progression-free survival (as assessed by blinded independent radiology review committee) for patients taking cabozantinib was 8.6 months (95% confidence interval [CI] = 6.8–14.0) compared with 5.3 months (95% CI = 3.0–8.2) for patients taking sunitinib (hazard ratio = 0.48; 95% CI = 0.31–0.74; P = .0008).

The most commonly reported (≥ 25%) adverse reactions in the cabozantinib clinical program are diarrhea, fatigue, nausea, decreased appetite, hypertension, palmar-plantar erythrodysesthesia, weight loss, vomiting, dysgeusia, and stomatitis. 

The most frequent grade 3–4 adverse reactions (≥ 5%) in patients treated with cabozantinib on CABOSUN were hypertension, diarrhea, hyponatremia, hypophosphatemia, palmar-plantar erythrodysesthesia, fatigue, ALT increase, decreased appetite, stomatitis, pain, hypotension, and syncope.

The recommended dose of cabozantinib is 60 mg orally, once daily.

Cabozantinib is also approved for the treatment of medullary thyroid cancer and is marketed under the trade name Cometriq. Cometriq and Cabometyx have different formulations and are not interchangeable.

Full prescribing information is available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/208692s000lbl.pdf.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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