— Blend improved PFS as opposed to extra hormonal therapy, but regulate arm questioned
by Mike BassettPersonnel Writer, MedPage Nowadays January 26, 2024
SAN FRANCISCO — In people with metastatic castration-resistant prostate most cancers (mCRPC) whose disorder progressed on a novel hormonal therapy, the blend of cabozantinib (Cabometyx) as well as atezolizumab (Tecentriq) enhanced radiographic progression-free survival (rPFS) vs . a swap to a 2nd hormonal agent, a section III demo confirmed.
The so-named Make contact with-02 research involved individuals with extrapelvic nodal or visceral metastasis with ailment progression immediately after either abiraterone (Zytiga) or enzalutamide (Xtandi).
Median rPFS arrived at 6.three months for individuals assigned to cabozantinib-atezolizumab compared to 4.2 months for all those switched to the reverse hormonal agent (HR .sixty five, 95% CI .fifty-.84, P=.0007), a “clinically meaningful improvement,” in accordance to Neeraj Agarwal, MD, of the Huntsman Cancer Institute at the University of Utah in Salt Lake City, who introduced the conclusions listed here.
A pattern for general survival (OS) favored the cabozantinib-atezolizumab arm (sixteen.7 vs fourteen.6 months, respectively HR .seventy nine, ninety five% CI .58-one.07, P=.13), even though these knowledge were being immature at the time of the evaluation, he noted at the Genitourinary Cancers Symposium.
This is the very first phase III research of a tyrosine kinase inhibitor (TKI) as well as immune checkpoint inhibitor (ICI) blend to display a important PFS enhancement in mCRPC, said Agarwal, who extra that the data help cabozantinib-atezolizumab as a probable new cure selection for a inhabitants with a extremely very poor prognosis.
Nevertheless, invited-discussant Kim N. Chi, MD, of the British Columbia Cancer Agency in Vancouver, explained he personally could not advise the blend, “given the facts that we’ve witnessed and the better possibilities that are available for this affected individual inhabitants.”
Chi referred to as the rPFS benefit only modest and cited a host of research limitations, which includes a lack of clarity on the certain contribution of cabozantinib and atezolizumab. “You should not forget about that cabozantinib monotherapy experienced an rPFS reward earlier explained of six.six months in a additional heavily pretreated population,” he stated.
Command Arm Questioned
Chi also questioned the selection of control arm, indicating that an androgen receptor pathway inhibitor (ARPI) switch is “not the greatest regular of care for this patient inhabitants with measurable condition and 40% visceral metastases.”
“There are far better options,” he reported, noting that docetaxel and cabazitaxel have demonstrated PFS prices of eight-nine months in period III trials.
Agarwal explained chemotherapy use is frequently restricted in this affected person populace thanks to considerations about toxicity, frailty, and individual preference, nonetheless.
When requested how investigators chose the handle arm for the demo, he famous that serious-environment scientific tests have proven that mCRPC patients are a lot less very likely to accept chemotherapy, and that novel hormonal remedy (NHT i.e., ARPIs) has under no circumstances been examined towards docetaxel in a randomized controlled trial just after NHT failure. “Centered on these two variables, regulatory bodies throughout the globe have acknowledged option NHT as a regulate arm.”
As for the possibility of making use of cabozantinib on your own in the regulate arm, Agarwal noted that it unsuccessful to substantially enhance OS in the section III COMET-one demoand that would have created it difficult as a regulate arm when seeking to convince institutional critique boards.
Contact-02 randomized 507 mCRPC patients one:one to obtain possibly oral cabozantinib the moment day by day plus IV atezolizumab just about every three weeks or next-line NHT with either oral abiraterone furthermore prednisone or oral enzalutamide when a working day.
Median age was seventy one yrs and individuals had a median baseline prostate-distinct antigen (PSA) level of 25-34 ng/mL. About eighty% of people had bone metastases and about 75% experienced enlarged lymph nodes.
Agarwal noted that the mix was notably successful in two prespecified subgroups of particular curiosity, people with liver metastases and those people with prior docetaxel:
- Liver metastases: median rPFS of six.two vs two.1 months (HR .forty three, ninety five% CI .27-.sixty eight)
- Prior docetaxel: 8.eight vs four.one months (HR .fifty seven, ninety five% CI .34-.ninety seven)
The goal response rate was fourteen% with the mix compared to four% with second NHT, with one% of clients in the blend arm attaining a total reaction.
As for protection, quality 5 treatment method-emergent adverse activities (TEAEs) happened in nine% and twelve% of the combination and NHT arms, respectively, and no quality five TEAEs happened in either arm. TEAEs led to the discontinuation of all treatment method components in 16% of the combination arm and fifteen% of NHT-swap arm.
Mike Bassett is a staff author concentrating on oncology and hematology. He is dependent in Massachusetts.
The analyze was funded by Exelixis.
Agarwal documented institutional study funding from Amgen, Arvinas, AstraZeneca, Bayer, Bristol Myers Squibb, Calithera Biosciences, Celldex, CRISPR Therapeutics, Eisai, Exelixis, Genentech, Gilead Sciences, Immunomedics, Janssen, Lilly, Merck, Nektar, ORIC, Pfizer, and Takeda, and vacation/lodging costs from Exelixis and Pfizer.
Chi reported individual and/or institutional economic interactions with Amgen, Astellas, AstraZeneca, Bayer, Bristol Myers Squibb, ESSA, Janssen, Merck, Novartis, Pfizer, Stage Biopharma, and Roche.
Genitourinary Cancers Symposium
Supply Reference: Agarwal N, et al “Get in touch with-two: Period three examine of cabozantinib plus atezolizumab vs next novel hormonal treatment in individuals with metastatic castration-resistant prostate cancer” GUCS 2024 Abstract 18.