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Modeling Spontaneous Metastatic Renal Cell Carcinoma mRCC in Mice Following Nephrectomy
Published on: April 29, 2014
Spotlight on cabozantinib for previously untreated advanced renal cell carcinoma: evidence to date
Melissa Bersanelli1, Francesco Leonardi1, Sebastiano Buti1
1University Hospital of Parma, Medical Oncology Unit, Parma, Italy, bersamel@libero.it.
Background:
In the past few years, new drugs made their appearance in the first-line setting of treatment for metastatic renal cell carcinoma (mRCC), and cabozantinib is one among them. The present systematic review aims to point out any evidence published to date about first-line treatment with cabozantinib for mRCC patients, describing their outcome in all end points explored by the literature.
Methods:
PRISMA guidelines were followed. A systematic assessment of literature and peer- reviewed presentations was performed by searching PubMed and major oncology meeting resources, from the database inception until June 25, 2018. The following keywords were used: "cabozantinib or cabozantinib-s-malate or XL184" and "renal cell carcinoma or kidney cancer or clear cell renal carcinoma or renal cancer" and "first-line or untreated or treatment-naïve or primary treatment". All types of original clinical studies were included, evaluating either cabozantinib monotherapy or any systemic drug combination containing cabozantinib for previously untreated patients with mRCC.
Results:
From potential 75 titles and abstracts, seven publications were selected. One was the main report of a randomized clinical trial (the CABOSUN study); four papers reported updated results, secondary or subgroup analyses from the same study population; and further two reports consisted of network meta-analyses. From the additional search for ongoing clinical trials, six studies currently in progress were reported.
Conclusion:
According to the reported evidence, cabozantinib may be a viable first-line option in mRCC patients with intermediate or poor risk according to International Metastatic Renal Cell Carcinoma Database Consortium model. It offers an undoubtful advantage in terms of progression-free survival, despite quite high rates of G3-4 toxicity, modest objective response rate, and no survival advantage. Nevertheless, given the availability of an immunotherapy combination that significantly improved overall survival for the same population in a Phase III trial and the indisputable efficacy of cabozantinib as second-line treatment, this drug may be devoted as a rescue option in patients progressive to primary therapy.
Insights
Cabozantinib shows promise as a first-line treatment for metastatic renal cell carcinoma (mRCC), improving progression-free survival. However, its role may be limited due to toxicity and the availability of other effective therapies.
Area of Science:
- Oncology
- Pharmacology
Background:
- Metastatic renal cell carcinoma (mRCC) treatment landscape has evolved with new drugs.
- Cabozantinib is a notable new agent in the first-line setting for mRCC.
Purpose of the Study:
- To systematically review existing evidence on first-line cabozantinib for mRCC.
- To describe patient outcomes across all endpoints explored in the literature.
Main Methods:
- Followed PRISMA guidelines for systematic literature assessment.
- Searched PubMed and oncology meeting resources up to June 25, 2018.
- Included original clinical studies of cabozantinib monotherapy or combinations in treatment-naïve mRCC patients.
Main Results:
- Seven publications were selected from 75 titles/abstracts.
- Included one randomized trial (CABOSUN), updated analyses, and network meta-analyses.
- Six ongoing clinical trials were identified.
Conclusions:
- Cabozantinib may be a first-line option for intermediate/poor risk mRCC patients.
- Offers progression-free survival benefits but has high toxicity and modest response rates.
- Considered a rescue option due to immunotherapy combinations showing improved overall survival.
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