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Oxaliplatin Treatment Of Early-Stage Colon Cancer

Cabozantinib and Atezolizumab Combo Has Synergistic Activity in Metastatic CRPC

Date : 2/9/2020 / Visit Count : 198
Cabozantinib and Atezolizumab Combo Has Synergistic Activity in Metastatic CRPC

n an interim analysis of expansion cohort 6 of the COSMIC-021 phase Ib study, which included subjects with CRPC and radiological progression in the soft tissue following enzalutamide (Xtandi) and abiraterone (Zytiga), the objective response rate (ORR) in 44 patients who received the combination was 32% (80% CI, 23%-42%), which included 2 (4.5%) with complete responses and 12 (27%) with partial responses,1 said Neeraj Agarwal, MD, who presented the data at the 2020 Genitourinary Cancers Symposium. In addition to the 14 responses, 21 patients (48%) had stable disease, for a disease control rate of 80%.

No new safety signals were uncovered with the combination. Only 1 patient had a grade 5 treatment-related adverse event (TRAE), which was dehydration in a 90-year-old patient with a 6-month history of heart failure. The overall rate of grade 3/4 TRAEs was 59%.

As single agents, cabozantinib and atezolizumab demonstrated ORRs of 5% and 0%,2,3 respectively, in metastatic CRPC. According to Agrawal, professor of Medicine at Huntsman Cancer Center of the University of Utah in Salt Lake City, “cabozantinib promotes an immune-permissive environment that may enhance response to immune checkpoint inhibitors.”

The clinical activity with the combination as opposed to monotherapy “is clearly indicative of synergy between these 2 drugs rather than merely additive actions,” he said

 

The only viable option known to improve overall survival (OS) and progression-free survival in patients with measurable disease or soft-tissue metastases after novel hormonal therapy is taxane chemotherapy, said Agarwal. “This combination has the potential to allow a nonchemotherapy option for those patients who are progressing on these earlier therapies and have limited options to date,” he said.

He continued, “When patients progress to the metastatic CRPC state after abiraterone, enzalutamide, or even apalutamide [Erleada], the median OS is 15 months. I think this is the most challenging patient population.”