Cora N. Sternberg, MD, FACP, Chief of Medical Oncology at San Camillo Forlanini Hospital, Rome, Italy, discussed the implications of the METEOR trial. Everolimus (Afinitor) is considered standard second-line therapy, with a benchmark progression-free survival of 4.9 months in the RECORD-1 trial, she explained. In that trial, there was no difference in overall survival between everolimus and placebo, due to the fact that 80% of patients in the placebo arm crossed over to receive everolimus.

“The primary endpoint of a 42% reduction in risk of disease progression or death observed in METEOR with cabozantinib [Cometriq] is encouraging, with practically double progression-free survival,” Dr. Sternberg told listeners. “The overall survival trend is encouraging, but the data are not yet mature.”

“Cabozantinib was developed to target the AXL and MET receptors and kinases associated with resistance and poor prognosis. The mechanism of action of cabozantinib is different from that of everolimus and is designed to overcome resistance to other tyrosine kinase inhibtors. The safety of cabozantinib is acceptable, and it is a new option for second- or later-line therapy of advanced renal cell carcinoma,” she stated.

Greatest Benefit

Dr. Sternberg pointed out that patients treated with only one prior VEGF-targeted agent had the greatest benefit from cabozantinib, along with moderate- and favorable-risk patients. “A biomarker to predict response to cabozantinib would be important, but currently we don’t have one. Keep in mind that the results apply to the type of patients enrolled in this trial, but the efficacy was impressive with cabozantinib vs everolimus,” she concluded.

Dr. Sternberg was a principal investigator in both the METEOR trial and the CheckMate 025 trial of nivolumab (Opdivo) in renal cell carcinoma [see page 1 for more details on the CheckMate 025 trial].   ■

Disclosure: Dr. Sternberg has received research funding or honoraria from Pfizer, Novartis, Bayer, AVEO, Roche, BMS, Exelexis, and GSK.