Combination of Cabozantinib/Ipilimumab/Nivolumab Investigated in RCC

Bradley McGregor, MD, clinical director, Lank Center for Genitourinary Oncology, senior physician, Dana-Farber Cancer Institute, and instructor of medicine, Harvard Medical School, discusses the ongoing COSMIC-313 trial (NCT03937219) of cabozantinib (Cabometyx), ipilimumab (Yervoy), and nivolumab (Opdivo) in patients with renal cell carcinoma (RCC).

COSMIC-313 is a randomized trial of this combination compared with nivolumab and ipilimumab. In this setting, there are many different VEGF inhibitors and immune-oncology (IO) combinations with slightly different toxicity profiles and different drugs. There are also IO-IO combinations—for these, it seems like there are a group of patients who have a durable response and are able to go off of therapy, according to McGregor. It is uncertain if this response will be seen with VEGF and IO combinations since those data are still maturing. With IO-IO combinations for patients with RCC, over 20% have progressive disease as their best response.

McGregor says the hope with COSMIC-313 is that the triplet combination of nivolumab and ipilimumab with cabozantinib will be able to overcome the progressive disease as best response for these patients. He also hopes that this combination will maintain a point where patients can continue on therapy and have durability of their response.