Press Release
Press Release
Exelixis Announces Detailed Results from Phase 3 STELLAR-303 Pivotal Trial Evaluating Zanzalintinib in Combination with an Immune Checkpoint Inhibitor in Metastatic Colorectal Cancer Presented at ESMO 2025 and Published in The Lancet
– Zanzalintinib in combination with atezolizumab improved median overall survival to 10.9 months versus 9.4 months with regorafenib, and significantly reduced the risk of death by 20% in the intention-to-treat population –
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“While treating non-MSI-high metastatic colorectal cancer remains a challenge, the combination of zanzalintinib and atezolizumab has shown consistent benefits across key subgroups of patients,” said
An OS benefit with the combination was consistently observed across pre-specified subgroups, including geographic region, RAS status, liver involvement and prior anti-VEGF therapy, as presented in Table 1 below. The 12- and 24-month landmark OS estimates were 46% (95% CI: 41-51) and 20% (95% CI: 15-26), respectively, for the combination of zanzalintinib and atezolizumab, and 38% (95% CI: 34-43) and 10% (95% CI: 6-16), respectively, for regorafenib.
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TABLE 1 |
Median OS, months (95% CI) |
HR (95% CI) |
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Zanzalintinib + Atezolizumab |
Regorafenib |
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Geographic region |
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|
11.5 (9.2-13.7) |
8.8 (7.8-10.4) |
0.77 (0.59-1.00) |
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Rest of the world |
10.9 (9.3-12.3) |
9.8 (8.3-10.9) |
0.82 (0.68-0.99) |
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RAS status |
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Wild type |
12.0 (10.1-14.6) |
10.4 (8.7-12.3) |
0.79 (0.61-1.01) |
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Mutant |
10.3 (9.0-11.9) |
8.7 (8.1-9.8) |
0.80 (0.66-0.98) |
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Active liver metastases |
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Presence |
8.9 (8.0-9.9) |
7.7 (6.5-8.5) |
0.78 (0.65-0.94) |
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Absence |
15.9 (13.5-17.6) |
12.8 (10.9-15.5) |
0.77 (0.59-1.01) |
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Prior anti-VEGF antibody treatment |
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Yes |
10.6 (9.3-12.5) |
8.8 (8.3-9.9) |
0.80 (0.68-0.95) |
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No |
11.5 (8.7-13.5) |
11.1 (9.5-12.6) |
0.80 (0.56-1.15) |
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OS = overall survival; CI = confidence interval; HR = hazard ratio; VEGF = vascular endothelial growth factor |
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Data pertaining to the other dual primary endpoint, OS in patients without liver metastases (non-liver metastases, NLM), were immature at the data cutoff. A prespecified interim analysis showed a trend in OS favoring the combination (15.9 months versus 12.8 months; stratified HR: 0.79; 95% CI: 0.61-1.03; P=0.0875) at a median follow-up of 16.8 months. The trial will proceed to the planned final analysis for this endpoint.
“These detailed results from STELLAR-303 provide further insight into the combination of zanzalintinib and atezolizumab as a potential new option to extend survival in patients with previously treated metastatic colorectal cancer,” said
A trend for improvement in PFS with the combination was also observed in the ITT population (stratified HR: 0.68 [95% CI: 0.59–0.79]; median, 3.7 [95% CI: 3.5–3.8] months versus 2.0 [95% CI: 1.9–2.6] months), though statistical superiority cannot be claimed at this time due to the prespecified hierarchical testing strategy. The trend for PFS improvement with zanzalintinib in combination with atezolizumab versus regorafenib was consistent across subgroups.
The safety profiles of zanzalintinib in combination with atezolizumab and of regorafenib were generally consistent with what has been previously observed, and no new safety signals were identified. Grade 3/4 treatment-related adverse events (AEs) occurred in 59% of patients receiving zanzalintinib in combination with atezolizumab and 37% of patients receiving regorafenib. AEs leading to discontinuation of all study treatment occurred in 18% versus 15% of patients, respectively. The most common grade 3/4 treatment-related AEs were hypertension (15% versus 9%, respectively), fatigue (6% versus 2%), diarrhea (6% versus 2%) and proteinuria (6% versus 2%). Deaths considered related to treatment by investigators were two for zanzalintinib, two for atezolizumab, one for the combination and one for regorafenib.
About STELLAR-303
STELLAR-303 (NCT05425940) is a global, multicenter, randomized, phase 3, open-label study that randomized patients 1:1 to either zanzalintinib in combination with atezolizumab (n=451) or regorafenib (n=450). The study includes patients with previously treated non-MSI-high metastatic CRC. The dual primary endpoints of the study are OS in the ITT population and in the NLM subgroup of patients. The ITT population consisted of all randomized patients, regardless of the presence of liver metastases. The NLM subgroup consisted of patients who did not have active liver metastases at baseline as determined by investigator assessment. Secondary endpoints include PFS, objective response rate and duration of response in the ITT population and in the NLM subgroup of patients. More information about the trial is available at ClinicalTrials.gov.
About Zanzalintinib
Zanzalintinib is a novel oral kinase inhibitor that inhibits the activity of the TAM kinases (TYRO3, AXL, MER), MET and VEGF receptors. These kinases play important roles in oncogenic processes including tumor cell proliferation, metastasis, angiogenesis, drug resistance and evasion of antitumor immunity. With zanzalintinib,
Zanzalintinib is an investigational agent that is not approved for any use and is the subject of ongoing clinical trials.
About CRC
CRC is the third most common cancer and the second leading cause of cancer-related deaths in the
About
Forward-Looking Statements
This press release contains forward-looking statements, including, without limitation, statements related to: the presentation of detailed results from the STELLAR-303 pivotal trial at ESMO 2025; the therapeutic potential of zanzalintinib in combination with atezolizumab to become a new and effective treatment option to extend survival for patients with previously treated metastatic CRC; Exelixis’ plans to complete a new drug application submission for zanzalintinib in the
TECENTRIQ is a registered
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| 1 Key Statistics for Colorectal Cancer. ACS website. Available at: https://www.cancer.org/cancer/types/colon-rectal-cancer/about/key-statistics.html. Accessed |
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2 Cancer Stat Facts: Colorectal Cancer. SEER website. Available at: https://seer.cancer.gov/statfacts/html/colorect.html. Accessed |
| 3 Ros J, Salva F, Dopazo C, et al. Liver transplantation in metastatic colorectal cancer: are we ready for it? Br |
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EVP, Public Affairs and
Investor Relations
650-837-8194
shubbard@exelixis.com
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Stekki Millman
Senior Director, Public Affairs
650-837-7187
smillman@exelixis.com
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