Treatment Outcomes in Patients With Bone Metastasis From Advanced RCC

Key Points

  • Cabozantinib was associated with improved outcomes vs everolimus in patients with bone metastases.
  • Median progression-free survival was 7.4 vs 2.7 months. 

In a subgroup analysis of the phase III METEOR trial of advanced renal cell carcinoma (RCC) patients with with bone metastases, cabozantinib was associated with improved outcomes vs everolimus. The analysis was reported by Escudier et al in the Journal of Clinical Oncology.

Study Details

In the METEOR trial, 658 patients with advanced RCC after previous vascular endothelial growth factor receptor inhibitor therapy were randomized to receive cabozantinib at 60 mg or everolimus at 10 mg daily. Among all patients, cabozantinib was associated with improved progression-free survival, overall survival, and objective response rate. The current prespecified subgroup analysis was based on baseline bone metastasis status according to an independent radiology committee (IRC).

Outcomes in Patients With Bone Metastases

Among the 77 cabozantinib and 65 everolimus recipients with bone metastases at baseline, median progression-free survival was 7.4 months vs 2.7 months (hazard ratio [HR] = 0.33, 95% confidence interval [CI] = 0.21–0.51); median overall survival was 20.1 months vs 12.1 months (HR = 0.54, 95% CI = 0.34–0.84); and overall response rate according to IRC was 17% vs 0%. Skeletal-related events occurred in 23% vs 29% of patients, and bone scan response rates were 20% vs 10%. The safety profiles of cabozantinib and everolimus in patients with bone metastases were consistent with those in patients without bone metastases.

Progression-free survival, overall survival, and overall response rate were also improved among cabozantinib recipients without bone metastases. Patients treated with cabozantinib had greater changes in bone biomarkers, including bone-specific alkaline phosphatase, the bone formation marker N-terminal propeptide of type 1 collagen, and the bone resorption marker C-terminal cross-linked telopeptides of type I collagen.

The investigators concluded, “Cabozantinib treatment was associated with improved [progression-free survival, overall survival, and objective response rate] when compared with everolimus treatment in patients with advanced RCC and bone metastases and represents a good treatment option for these patients.”

Editorial support for the article was funded by Exelixis.

Bernard Escudier, MD, of Institut Gustave Roussy, is the corresponding author for the Journal of Clinical Oncology article. 

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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