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Activity of Cabozantinib in Advanced Non–Clear Cell Renal Cell Carcinoma

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Key Points

  • Objective response was observed in 27% of patients.
  • Responses were observed across histologies.

In a retrospective cohort study reported in The Lancet Oncology, Chanzá et al found evidence of activity of cabozantinib in advanced non–clear cell renal carcinoma.

Cabozantinib is approved in metastatic renal cell carcinoma on the basis of studies in clear cell histology. As noted by the investigators, the activity of cabozantinib in non–clear cell renal cell carcinoma is poorly defined.

Study Details

The study involved data from patients with metastatic disease treated with cabozantinib during any treatment line at 21 centers in the United States and 1 in Belgium between 2015 and 2018. Mixed tumors with a clear cell histology component were excluded.

Among 112 patients identified at the participating centers, 66 (59%) had papillary histology, 17 (15%) had Xp11.2 translocation histology, 15 (13%) had unclassified histology, 10 (9%) had chromophobe histology, and 4 (4%) had collecting duct histology.

Response Rates

Objective response was observed in 30 patients (27%), including 18 (27%) with papillary histology, 5 (29%) with Xp11.2 translocation histology, 2 (13%) with unclassified histology, 3 (30%) with chromophobe histology, and 2 (50%) with collecting duct histology. An additional 53 patients (47%) had stable disease.

At a median follow-up of 11 months, the median time to treatment failure was 6.7 months, median progression-free survival was 7.0 months, and median overall survival was 12.0 months. Among 54 patients with available next-generation sequencing data, the most frequently altered somatic genes were CDKN2A (12 patients, 22%) and MET (11 patients, 20%).

Objective responses were observed irrespective of mutational status. For example, responses were observed in 4 patients (all with papillary histology) with CDKN2A alterations and in 4 of 10 patients with papillary histology and MET alterations.

Adverse Events

The most common adverse events of any grade were fatigue (52%), diarrhea (34%), and skin toxicity (31%). The most common grade 3 adverse events were skin toxicity (rash and palmar-plantar erythrodysesthesia; 4%) and hypertension (4%). No treatment-related deaths were observed.

The investigators concluded, “While we await results from prospective studies, this real-world study provides evidence supporting the antitumour activity and safety of cabozantinib across non–clear cell renal cell carcinomas. Continued support of international collaborations and prospective ongoing studies targeting non–clear cell renal cell carcinoma subtypes and specific molecular alterations are warranted to improve outcomes across these rare diseases with few evidence-based treatment options.”

Lauren C. Harshman, MD, of the Lank Center for Genitourinary Cancers, Dana-Farber Cancer Institute, is the corresponding author for The Lancet Oncology article.

Disclosure: The study authors' full disclosures can be found at thelancet.com.

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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