PracticeUpdate: Haematology & Oncology

ECCO2017 9

Cabozantinib proves superior to everolimus in advanced renal cell carcinoma with bonemetastases R esults of the phase III METEOR trial of cabozantinib vs everolimus in advanced renal cell carcinoma have demonstrated that cabozantinib is superior to everolimus. Toni Choueiri, MD, of Dana-Farber Cancer Institute, Boston, Massachusetts, explained that bone metastases are associated with poor outcomes in patients with metastatic renal cell carcinoma. METEOR evaluated the efficacy and safety of cabo- zantinib vs everolimus in patients with previously treated advanced renal cell carcinoma. Overall survival was significantly prolonged with cabozantinib with a median overall survival of 21.4 vs 16.5 months with everolimus (hazard ratio 0.66, 95% CI 0.53–0.83, P = 0.0003). Progression-free survival and objective response rate were also significantly improved with cabozantinib vs everolimus [HR for progression-free survival 0.51 (95% CI 0.42– 0.62, P < 0.0001). Cabozantinib showed activity in bone metastases in preclinical and clinical studies performed in 2014. Dr Choueiri reported outcomes in patients enrolled in METEOR with bone metastases. A total of 658 patients were stratified by Memorial Sloan Kettering Cancer Center risk group and number of prior vascular endothelial growth factor receptor tyrosine kinase inhibitors and randomised 1:1 to cabozantinib (60 mg qd) or everolimus (10 mg qd). Clinical outcomes included progression-free survival, objective response rate, overall survival, and safety. Exploratory endpoints were bone scan response per independ- ent radiology committee in patients with bone scan lesions at baseline, incidence of skeletal-related events, and changes in bone turnover markers. At baseline, 142 patients harboured bone metastases and 112, visceral metastases as well. Patients with bone metastases were distributed in Memorial Sloan Kettering Can- cer Center risk group consistently with the overall study population. Hazard ratios for progression-free survival with cabozantinib vs everolimus were 0.33 (95% CI 0.21–0.51) in patients with bone and 0.26 (95% CI 0.16–0.43) for patients with bone and visceral metastases. Overall survival was also markedly improved, with hazard ratios of 0.54 (95% CI 0.34–0.84) in patients with bone metastases (median overall survival 20.1 months for cabozantinib vs 12.1 months for everolimus) and 0.45 (95% CI 0.28–0.72) in patients with bone and visceral metastases (median overall survival was 20.1 months with cabo- zantinib vs 10.7 months with everolimus). The objective response rate per independent radiology committee with cabozantinib was 17% for patients with bone metastases and 20% for those with bone and visceral metastases. Bone scan response per independent radiology committee was 18% with cabozantinib vs 10% with everolimus. At least one skeletal-related event occurred in 12% (cabo- zantinib) and 14% (everolimus) of patients, in four cabozantinib and eight everolimus cases of spinal cord compression. For patients with a history of skeletal-related events at randomisation, the incidence of postrandomisation skeletal-related events was 16% (cabozantinib) and 34% (everolimus) and included 0 (cabozantinib) and five (everolimus) cases of spinal cord compression. Reductions in bone markers P1NP and CTx were greater with cabozantinib than with everolimus. The most common adverse events in patients with bone metastases were consistent with those observed in the overall study population. Dr Choueiri concluded that progression-free and overall survival, as well as the objec- tive response rate, in patients with bone metastases were improved with cabozantinib vs everolimus and consistent with results for the overall population. Outcomes in bone metastasis-related endpoints supported the observed superior efficacy of cabozantinib vs everolimus in METEOR.

When diagnosing local recurrence of prostate cancer in the early stages of recurrence, multiparametric MRI is superior to PET and CT scanning. Patients who present with de novo metastatic breast cancer and harbour fewer than two sites of metastatic disease are more likely to achieve prolonged overall survival when treated

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with HER2 therapy in combination with chemotherapy.

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Preliminary results have shown that eribulin can potentially suppress the epithelial-mesenchymal transition... after eribulin treatment, epithelial makers were increased and mesenchymal markers decreased in two-thirds of tumours.

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PracticeUpdate Editorial Team

VOL. 2 • NO. 2 • 2017