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A metanalysis on cabozantinib and bone metastases: true story or commercial gimmick?
Melissa Bersanelli1,2, Sebastiano Buti2, Antonio Ghidini3
1Medicine and Surgery Department, University of Parma, Parma, Italy.
Abstract:
Is it true that cabozantinib should be the preferred option treating patients with bone metastases? Are there any reliable comparisons between this drug and other standard options in this subgroup? To address the issue, we performed a systematic review and metanalysis of randomized trials with cabozantinib, to assess its effectiveness, in terms of overall survival, according to the presence of bone metastases. We included (a) randomized controlled trials; (b) any solid tumors and therapeutic line; and (c) overall survival data available according to the site of disease. Cabozantinib improved overall survival both for the group with bone metastases, with risk of death decreased by 53% (hazard ratio, 0.47; 95% confidence interval, 0.26-0.87; P=0.02) and for the group without bone metastases, decreasing the risk of death by 44% (hazard ratio, 0.56; 95% confidence interval, 0.40-0.79; P=0.001) over the standard of care. The difference was not significantly different between the two groups. Despite cabozantinib can be undoubtedly listed as a good therapeutic option for cancer patients with bone metastases, it seems that its preclinical profile against bone remodeling does not translate into an actual clinical relevance, preventing from considering the presence of bone metastases as principal criterion for the choice of this drug.
Insights
Cabozantinib improves overall survival in cancer patients with and without bone metastases. However, its preclinical bone remodeling profile doesn't make bone metastases a primary selection criterion.
Area of Science:
- Oncology
- Clinical Pharmacology
Background:
- Bone metastases are a common complication in various solid tumors.
- The efficacy of cabozantinib in patients with bone metastases requires further investigation compared to standard treatments.
Purpose of the Study:
- To systematically review and meta-analyze randomized controlled trials to assess cabozantinib's effectiveness in improving overall survival.
- To compare the efficacy of cabozantinib in patients with and without bone metastases.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials.
- Inclusion criteria: randomized controlled trials, any solid tumors, any therapeutic line, and overall survival data stratified by disease site (bone metastases vs. no bone metastases).
Main Results:
- Cabozantinib significantly improved overall survival in patients with bone metastases (HR, 0.47; P=0.02) and without bone metastases (HR, 0.56; P=0.001) compared to standard care.
- No significant difference in survival benefit was observed between the groups with and without bone metastases.
Conclusions:
- Cabozantinib is a valuable therapeutic option for cancer patients, including those with bone metastases.
- The presence of bone metastases should not be the principal criterion for selecting cabozantinib, as its preclinical bone remodeling effects do not appear to confer a distinct clinical advantage in this subgroup.
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