Sumanta K. Pal, MD, on Urothelial Carcinoma: New Results on Cabozantinib Plus Atezolizumab
2022 ASCO Annual Meeting
Sumanta K. Pal, MD, of City of Hope National Medical Center, discusses findings from the COSMIC-021 study, which showed that cabozantinib plus atezolizumab demonstrated encouraging clinical activity with manageable toxicity in patients with inoperable locally advanced or metastatic urothelial carcinoma. The combination was administered as first-line therapy in cisplatin-based chemotherapy–eligible and –ineligible patients and as second- or later-line treatment in those who received prior immune checkpoint inhibitors (Abstract 4504).
Transcript
Disclaimer: This video transcript has not been proofread or edited and may contain errors.
The COSMIC-021 study is a trial that includes multiple different histologies, multiple different cohorts. At this year's ASCO meeting, ASCO 2022, I presented data pertaining to cohorts three, four, and five. This specifically looked at patients with advanced urothelial carcinoma. The composition of each of the cohorts was distinct. In cohort three, we had patients that were cisplatin-ineligible. In cohort four, patients that were cisplatin-eligible. And finally, in cohort five, patients that had received prior immune checkpoint inhibitors. What ultimately it boiled down to is about 30 patients per cohort. In terms of the distribution of patients, it was predominantly male, as you might expect. Most of the patients had a bladder primary, although we did actually have good representation of upper track tumors, ureteral tumors, and so forth. That was about 30% of the study population. Amongst those patients that had received prior immune checkpoint inhibitors, about 30% had received one prior therapy implying immune-based treatment, and about 68% had received two or more prior lines of treatment. What we saw was actually a graded response. In patients who were cisplatin-eligible we saw the highest response rate, 30%. In patients that cisplatin-ineligible we saw a response rate of 20%. And finally, in patients that had received prior immune checkpoint inhibitors, we saw a response rate of 10%. It's always tricky to know what endpoints to follow in these relatively small studies. One thing that really I found intriguing was the duration of response. And with substantial follow up at this point in time, we still haven't reached the median duration of response amongst those patients that were cisplatin-eligible. I really think that the toxicity profile that we saw in this study really mimics what we've seen in other experiences of cabozantinib with atezolizumab. The combination seems to be very well tolerated. We used a dose of cabozantinib at 40 milligrams. The rates of hepatitis, the rates of other toxicities that you'd expect with a combination like diarrhea, were very reasonable and manageable by and large. So in summary, I think that this combination really does have activity. My hope is that we'll be able to study it further in certain contexts. And in particular, there's a study ongoing right now that I'll plug, MAIN-CAV through the Alliance. It's led by Dr. Shilpa Gupta. This trial I think is a prime way for us to understand the role of cabozantinib with immunotherapy where that combination's being assessed in the maintenance setting.
The ASCO Post Staff
Erika Hamilton, MD, of Sarah Cannon Research Institute at Tennessee Oncology, discusses phase III data from the DESTINY-Breast03 study, which reinforced the consistent safety profile of fam-trastuzumab deruxtecan-nxki (T-DXd) vs ado-trastuzumab emtansine (T-DM1) in patients with HER2-positive unresectable and/or metastatic breast cancer. The findings also support T-DXd’s risk benefit over that of T-DM1 (Abstract 1000).
The ASCO Post Staff
Richard Finn, MD, of the Geffen School of Medicine at UCLA and the Jonsson Comprehensive Cancer Center, discusses analyses from the PALOMA-2 trial on overall survival with first-line palbociclib plus letrozole vs placebo plus letrozole in women with ER-positive/HER2-negative advanced breast cancer. The study met its primary endpoint of improving progression-free survival but not the secondary endpoint of overall survival. Although patients receiving palbociclib plus letrozole had numerically longer overall survival than those receiving placebo plus letrozole, the results were not statistically significant (Abstract LBA1003).
The ASCO Post Staff
Bradley J. Monk, MD, of the University of Arizona College of Medicine and Creighton University School of Medicine, discusses phase III findings from the ATHENA–MONO (GOG-3020/ENGOT-ov45) trial. It showed that rucaparib as first-line maintenance treatment, following first-line platinum-based chemotherapy, improved progression-free survival in patients with ovarian cancer, irrespective of homologous recombination deficiency status (Abstract LBA5500).
The ASCO Post Staff
Nancy Davidson, MD, of the Fred Hutchinson Cancer Research Center, reviews results from four abstracts about the importance of long-term follow-up in studies of adjuvant endocrine therapy for hormone receptor–positive breast cancer. Because the natural history of hormone receptor–positive breast cancer is long, an effort is underway to improve selection of patients by clinical parameters or biomarkers, refine the endocrine therapy background, and administer more effective combinations of endocrine therapy with other agents.
The ASCO Post Staff
Courtney D. DiNardo, MD, MSCE, of The University of Texas MD Anderson Cancer Center, and Jorge E. Cortes, MD, of Georgia Cancer Center at Augusta University, discuss phase III results from the ASCEMBL trial, which showed that after more than 2 years of follow-up, asciminib continued to yield superior efficacy and better safety and tolerability vs bosutinib in patients with chronic myeloid leukemia (CML) in chronic phase. These results continue to support the use of this kinase inhibitor as a new CML therapy, says Dr. Cortes, with the potential to transform the standard of care (Abstract 7004).