COSMIC-021 Trial Shows Efficacy and Tolerability in mCRPC

Neeraj Agarwal, MD, director of the Genitourinary Oncology Program, Oncology Division, and professor of medicine at the Huntsman Cancer Institute, University of Utah, discusses the efficacy of cabozantinib (Cabometyx) and atezolizumab (Tecentriq) in the COSMIC-021 study.

The phase Ib trial investigated patients with metastatic castration-resistant prostate cancer (mCRPC). Agarwal says that the responses from this trial have not been seen with any other combination in this setting, immunotherapy combinations or otherwise.

The median overall survival in this patient population is about 15 months, so there is an unmet need for these patients, Agarwal explains. Objective responses in the COSMIC-021 trial was 32% with the combination, and 47% of patients had stable disease, for a disease control rate of about 80%. He feels that the durability of the responses were even more remarkable. The median duration of response was 8 months.

Agarwal says that all these data make for exciting outcomes for patients with mCRPC. He thinks it is also important that the combination did not show any new safety signals. The adverse events (AEs) were mostly grade 1/2, and there were a few grade 3 AEs. Agarwal says there were no grade 4 AEs in these patients, which are older than other patient populations with other kinds of cancer.

Overall, Agarwal believes the objective responses, disease control rate, duration of responses, and high tolerability of this drug combination makes it a promising treatment regimen.

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