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– Study will evaluate the potential of this novel combination in multiple solid tumors, including advanced renal cell carcinoma and urothelial carcinoma –
– Expect to begin patient enrollment mid-year 2017 –
Based on the dose-escalation results, the trial has the potential to
enroll up to four expansion cohorts, including a cohort of patients with
previously untreated advanced clear cell renal cell carcinoma (RCC) and
three cohorts of urothelial carcinoma (UC), namely platinum eligible
first-line patients, first- or second-line platinum ineligible patients,
and patients previously treated with platinum-containing chemotherapy.
“People with advanced genitorurinary malignancies are in need of
additional treatment options that can improve clinical outcomes,” said
“We are pleased to collaborate with
The rationale for the collaboration is based on clinical and preclinical
observations consistent with the ability of cabozantinib to promote an
immunopermissive environment, which might present an opportunity for
synergistic effects from combination treatment with immune checkpoint
inhibitors and other immunotherapies.1,2 In an ongoing phase
1 clinical trial in subjects with refractory metastatic UC and other
genitourinary tumors, cabozantinib has been evaluated in combination
with nivolumab, a monoclonal antibody to PD-1. The combination was
well-tolerated among all enrolled subjects, no dose-limiting toxicities
were reported, and the recommended phase 2 dose was determined to be 40
mg qd for cabozantinib with 3 mg/kg of nivolumab (intravenous [IV], once
every two weeks).3 Updated results from this part of the
study as well as results from a second part evaluating the combination
of cabozantinib, nivolumab and ipilimumab were presented during the
poster session (Abstract #293) on
Exelixis’ cabozantinib is a potent inhibitor of multiple receptor
tyrosine kinases known to play important roles in tumor cell
proliferation and/or tumor neovascularization including MET, VEGFR, AXL
and RET. Some of these receptors have also been implicated in promoting
an immunosuppressive tumor microenvironment. Cabozantinib has
demonstrated broad preclinical and clinical activity across several
tumor types. Cabozantinib tablets (60 mg) are approved as CABOMETYX™ in
About Genitourinary Cancers
Genitourinary cancers are those that affect the urinary tract, bladder, kidneys, ureter, prostate, testicles, penis or adrenal glands — parts of the body involved in reproduction and excretion — and include renal cell carcinoma and urothelial carcinoma.4
Kidney cancer is among the top ten most commonly diagnosed forms of cancer among both men and women in the U.S., according to the American Cancer Society’s 2016 statistics.5 Clear cell RCC is the most common type of kidney cancer in adults.6 If detected in its early stages, the five-year survival rate for RCC is high; for patients with advanced or late-stage metastatic RCC, however, the five-year survival rate is only 12 percent, with no identified cure for the disease.5 Approximately 30,000 patients in the U.S. and 68,000 globally require treatment.7
Urothelial cancers encompass carcinomas of the bladder, ureter and renal pelvis at a ratio of 50:3:1, respectively.8 Urothelial carcinoma occurs mainly in older people, with 90 percent of patients aged 55 or older.9 Bladder cancer is the fourth most common cancer in men and accounts for about five percent of all new cases of cancer in the U.S. each year.9 In 2013, an estimated 587,426 people were living with bladder cancer in the U.S.10
About CABOMETYX™ (cabozantinib)
CABOMETYX is the tablet formulation of cabozantinib. Its targets include MET, AXL and VEGFR-1, -2 and -3. In preclinical models, cabozantinib has been shown to inhibit the activity of these receptors, which are involved in normal cellular function and pathologic processes such as tumor angiogenesis, invasiveness, metastasis and drug resistance.
CABOMETYX is available in 20 mg, 40 mg or 60 mg doses. The recommended dose is 60 mg orally, once daily.
U.S. Important Safety Information
Hemorrhage: Severe hemorrhage occurred with CABOMETYX. The incidence of Grade ≥3 hemorrhagic events was 2.1% in CABOMETYX-treated patients and 1.6% in everolimus-treated patients. Fatal hemorrhages also occurred in the cabozantinib clinical program. Do not administer CABOMETYX to patients that have or are at risk for severe hemorrhage.
Gastrointestinal (GI) Perforations and Fistulas: Fistulas were reported in 1.2% (including 0.6% anal fistula) of CABOMETYX-treated patients and 0% of everolimus-treated patients. GI perforations were reported in 0.9% of CABOMETYX-treated patients and 0.6% of everolimus-treated patients. Fatal perforations occurred in the cabozantinib clinical program. Monitor patients for symptoms of fistulas and perforations. Discontinue CABOMETYX in patients who experience a fistula that cannot be appropriately managed or a GI perforation.
Thrombotic Events: CABOMETYX treatment results in an increased incidence of thrombotic events. Venous thromboembolism was reported in 7.3% of CABOMETYX-treated patients and 2.5% of everolimus-treated patients. Pulmonary embolism occurred in 3.9% of CABOMETYX-treated patients and 0.3% of everolimus-treated patients. Events of arterial thromboembolism were reported in 0.9% of CABOMETYX-treated patients and 0.3% of everolimus-treated patients. Fatal thrombotic events occurred in the cabozantinib clinical program. Discontinue CABOMETYX in patients who develop an acute myocardial infarction or any other arterial thromboembolic complication.
Hypertension and Hypertensive Crisis: CABOMETYX treatment results in an increased incidence of treatment-emergent hypertension. Hypertension was reported in 37% (15% Grade ≥3) of CABOMETYX-treated patients and 7.1% (3.1% Grade ≥3) of everolimus-treated patients. Monitor blood pressure prior to initiation and regularly during CABOMETYX treatment. Withhold CABOMETYX for hypertension that is not adequately controlled with medical management; when controlled, resume CABOMETYX at a reduced dose. Discontinue CABOMETYX for severe hypertension that cannot be controlled with anti-hypertensive therapy. Discontinue CABOMETYX if there is evidence of hypertensive crisis or severe hypertension despite optimal medical management.
Diarrhea: Diarrhea occurred in 74% of patients treated with CABOMETYX and in 28% of patients treated with everolimus. Grade 3 diarrhea occurred in 11% of CABOMETYX-treated patients and in 2% of everolimus-treated patients. Withhold CABOMETYX in patients who develop intolerable Grade 2 diarrhea or Grade 3-4 diarrhea that cannot be managed with standard antidiarrheal treatments until improvement to Grade 1; resume CABOMETYX at a reduced dose. Dose modification due to diarrhea occurred in 26% of patients.
Palmar-Plantar Erythrodysesthesia Syndrome (PPES): Palmar-plantar erythrodysesthesia syndrome (PPES) occurred in 42% of patients treated with CABOMETYX and in 6% of patients treated with everolimus. Grade 3 PPES occurred in 8.2% of CABOMETYX-treated patients and in <1% of everolimus-treated patients. Withhold CABOMETYX in patients who develop intolerable Grade 2 PPES or Grade 3 PPES until improvement to Grade 1; resume CABOMETYX at a reduced dose. Dose modification due to PPES occurred in 16% of patients.
Reversible Posterior Leukoencephalopathy Syndrome (RPLS): RPLS, a syndrome of subcortical vasogenic edema diagnosed by characteristic finding on MRI, occurred in the cabozantinib clinical program. Perform an evaluation for RPLS in any patient presenting with seizures, headache, visual disturbances, confusion, or altered mental function. Discontinue CABOMETYX in patients who develop RPLS.
Embryo-fetal Toxicity: CABOMETYX can cause fetal harm when administered to a pregnant woman. Advise pregnant women of the potential risk to a fetus. Advise females of reproductive potential to use effective contraception during treatment with CABOMETYX and for 4 months after the last dose.
Adverse Reactions: The most commonly reported (≥25%) adverse reactions are: diarrhea, fatigue, nausea, decreased appetite, PPES, hypertension, vomiting, weight decreased, and constipation.
Drug Interactions: Strong CYP3A4 inhibitors and inducers: Reduce the dosage of CABOMETYX if concomitant use with strong CYP3A4 inhibitors cannot be avoided. Increase the dosage of CABOMETYX if concomitant use with strong CYP3A4 inducers cannot be avoided.
Lactation: Advise a lactating woman not to breastfeed during treatment with CABOMETYX and for 4 months after the final dose.
Reproductive Potential: Contraception―Advise females of reproductive potential to use effective contraception during treatment with CABOMETYX and for 4 months after the final dose. Infertility ―CABOMETYX may impair fertility in females and males of reproductive potential.
Hepatic Impairment: Reduce the CABOMETYX dose in patients with mild (Child-Pugh score [C-P] A) or moderate (C-P B) hepatic impairment. CABOMETYX is not recommended for use in patients with severe hepatic impairment.
This press release contains forward-looking statements, including,
without limitation, statements related to: the expectation that
enrollment for the planned study to evaluate the safety and tolerability
of cabozantinib in combination with atezolizumab in patients with
locally advanced or metastatic solid tumors is scheduled to begin
mid-year 2017; the potential for the trial to enroll up to four
expansion cohorts; the potential for Takeda to participate in the
planned study and the potential for both
Kwilas, A. et al.
Journal of Translational Medicine2014, 12:294 http://www.translational-medicine.com/content/12/1/294.
Apolo, A. et al. Effect of Cabozantinib on Immunosuppressive Subsets
in Metastatic Urothelial Carcinoma. Presented at:
American Society of Clinical Oncology2014 Annual Meeting; May 30– June 3, 2014; Chicago, IL.
Apolo, A. et al. A Phase 1 Study of Cabozantinib Plus Nivolumab
(CaboNivo) in Patients with Refractory Metastatic Urothelial Carcinoma
and Other Genitourinary Tumors. Presented at:
European Society for Medical Oncology2016 Congress; October 7-11, 2016; Copenhagen, Denmark.
The University of Arizona Cancer Center. What are genitourinary cancers? http://uacc.arizona.edu/patients/clinic/gucancer/what-are-gu-cancers. Accessed September 27, 2016.
American Cancer Society. Cancer Facts & Figures 2016. Atlanta: American Cancer Society; 2016.
- Jonasch E., Gao J., Rathmell W.K., Renal cell carcinoma. BMJ. 2014; 349:g4797.
Decision Resources Report: Renal Cell Carcinoma.
October 2014(internal data on file).
Hurwitz, M. et al. Urothelial and Kidney Cancers. Cancer Management. http://www.cancernetwork.com/cancer-management/urothelial-and-kidney-cancers.
September 27, 2016.
American Cancer Society. Bladder Cancer Key Statistics. http://www.cancer.org/cancer/bladdercancer/detailedguide/bladder-cancer-key-statistics. Accessed May 23, 2016.
National Cancer Institute. SEER Stat Fact Sheets: Bladder Cancer. http://seer.cancer.gov/statfacts/html/urinb.html. Accessed May 23, 2016.