A phase I study of cabozantinib (XL184) in patients with renal cell cancer

Abstract

Background: Cabozantinib targets tyrosine kinases including the hepatocyte growth factor receptor (MET) and vascular endothelial growth factor (VEGF) receptor 2, which are important drug targets in renal cell carcinoma (RCC).

Patients and methods: This single-arm open-label phase I trial evaluated the safety and tolerability of cabozantinib in heavily pretreated patients with metastatic clear cell RCC.

Results: The study enrolled 25 RCC patients for whom standard therapy had failed. Patients received a median of two prior systemic agents, and most patients had previously received at least one VEGF pathway inhibiting therapy (22 patients [88%]). Common adverse events included fatigue, diarrhea, nausea, proteinuria, appetite decreased, palmar-plantar erythrodysesthesia, and vomiting. Partial response was reported in seven patients (28%). Median progression-free survival was 12.9 months, and median overall survival was 15.0 months.

Conclusion: Cabozantinib demonstrates preliminary anti-tumor activity and a safety profile similar to that seen with other multitargeted VEGFR tyrosine kinase inhibitors in advanced RCC patients. Further evaluation of cabozantinib in RCC is warranted. ClinicalTrials.gov identifier: NCT01100619.

Keywords: VEGFR-2; c-Met; clinical trial; receptor tyrosine kinase; renal cancer.

Figure 1.

Radiographic response in a patient with sarcomatoid differentiation. Prior therapies included sunitinib, gemcitabine, and everolimus.

Figure 2.

(A) Best target lesion change in patients with ≥1 post-baseline scan. Stable disease per RECIST is represented by the space between the dotted lines. Asterisks indicate a confirmed partial response. (B) Progression-free survival. (C) Overall survival.