Therapeutic Approach for Metastatic Renal Cell Carcinoma - Episode 4
Neeraj Agarwal, MD:In the CABOSUN trial, which was a phase II randomized trial of almost 160 patients comparing cabozantinib with sunitinib, cabozantinib was clearly superior to sunitinib in terms of progression-free survival, which was also confirmed by independent radiological assessment. The progression-free survival with cabozantinib was 8.6 months compared with 5.3 months for sunitinib. And this was a relatively high-risk patient population with only intermediate- and poor-risk patients being included, butmore notably—30% of patients had bone metastases. So, after confirming superiority of cabozantinib over sunitinib by an independent radiologic assessment, in my mind, cabozantinib is a drug of choice for this patient.
Going back to the question of sunitinib versus pazopanib, I did not choose pazopanib in this patient, because we already have data from the COMPARZ trial from a few years ago, where sunitinib was found to be equivalent to pazopanib or vice versa, as far as progression-free survival was concerned. So, we know that pazopanib and sunitinib are very comparable as far as progression-free survival is concerned, and cabozantinib is clearly superior to sunitinib from the CABOSUN trial. The extrapolation of the data basically leads me to believe that cabozantinib is also superior to pazopanib, with the caveat that these 2 drugs have not been compared head-to-head in a randomized clinical trial.
Transcript edited for clarity.
Case Scenario: A 73-year old female with rapidly progressing mRCC