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When diagnosing local
recurrence of prostate
cancer in the early
stages of recurrence,
multiparametric MRI is
superior to PET and CT
scanning.
>13
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
with HER2 therapy
in combination with
chemotherapy.
>14
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.
>17
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.
PracticeUpdate Editorial Team
ECCO2017
9
VOL. 2 • NO. 2 • 2017