Cabozantinib in mRCC

Daniel George, MD:This case, that we presented today—a 52-year-old gentleman that presented with metastatic disease at diagnosis, who, after surgery, had progressive disease, was started on cabozantinib, and saw a dose response, a partial response with that first scan—to me, this is a successful story. This is a case of somebody that’s likely to respond, for a long period of time, on this drug.

Even though we went from 60 mg down to 40 mg, I know that’s an active dose. I can maintain that patient for a long period of time. It’s also a patient who I know is going to have second- and, probably, third- or fourth-line therapies available to them, in the future. So, I haven’t burned any bridges by starting with a drug like this. I bought them time, and have gotten them a remission. I’ve got toxicities that we can manage. We can titrate with interruptions of dose modifications. So, to me, this is a successful kidney cancer case.

Now, we’ve still got work to do in the field. We’ve got to figure out how to get cases like this from a partial response to a complete response. We’ve got to understand more about this biology. This disease went from being a VEGF -targeted disease to a multitargeted disease, with MET and AXL. We’ve got immunotherapy, on the other hand, that is effective in this cancer. But this is not effective in everybody. We’ve got to figure out how to combine some of these strategies, either in sequence or combination. But ultimately, we’ve got more tools than ever, in this disease. Kidney cancer, to me, is probably one of our most promising diseases, now. Fifteen years ago, this was a disease that nobody ever wanted to see. And now, I’ve got patients who have had 15 years of metastatic disease.

You could feel good about treating these patients. You can feel good about using these agents in the frontline setting. You’re going to have to work on it. But, over time, your patients are going to get comfortable with this, and I think you’ll be satisfied, like me, with the progress that we’ve made.

Transcript edited for clarity.

Case Scenario: A 52-year old male with mRCC

February 2018

• A 52-year old Caucasian man presented to his physician complaining of severe left-sided back pain
• Laboratory findings: mild anemia, otherwise WNL
• CT scan of the abdomen and pelvis showed a large left renal mass, several small lytic lesions in the lumbar and thoracic vertebrae, and a small pulmonary nodule
• The patient underwent cytoreductive nephrectomy
• Diagnosis; stage IV clear-cell renal cell carcinoma; good-risk
• He received radiation therapy to his spinal lesions and was then started on cabozantinib 60 mg daily
• The patient reported moderate nausea and vomiting and diarrhea after 6 weeks on therapy; he continues to do well with improved tolerance after dose adjustment to 40 mg
• Imaging at 3 months showed a significant decrease in size of the pulmonary nodule