Cabozantinib plus Nivolumab and Ipilimumab in Renal-Cell Carcinoma

Authors:
  • TCToni K. Choueiri
    Toni K. Choueiri
  • TPThomas Powles
    Thomas Powles
  • LALaurence Albiges
    Laurence Albiges
  • MBMauricio Burotto
    Mauricio Burotto
  • CSCezary Szczylik
    Cezary Szczylik
  • BZBogdan Zurawski
    Bogdan Zurawski
  • EREduardo Yanez Ruiz
    Eduardo Yanez Ruiz
  • MMMarco Maruzzo
    Marco Maruzzo
  • LFLuis E. Fein
    Luis E. Fein
  • FSFabio A. Schutz
    Fabio A. Schutz
  • DHDaniel Y.C. Heng
    Daniel Y.C. Heng
Top Cited Papers
Publisher website
Google Scholar
Abstract
The efficacy and safety of treatment with cabozantinib in combination with nivolumab and ipilimumab in patients with previously untreated advanced renal-cell carcinoma are unknown. In this phase 3, double-blind trial, we enrolled patients with advanced clear-cell renal-cell carcinoma who had not previously received treatment and had intermediate or poor prognostic risk according to the International Metastatic Renal-Cell Carcinoma Database Consortium categories. Patients were randomly assigned to receive 40 mg of cabozantinib daily in addition to nivolumab and ipilimumab (experimental group) or matched placebo in addition to nivolumab and ipilimumab (control group). Nivolumab (3 mg per kilogram of body weight) and ipilimumab (1 mg per kilogram) were administered once every 3 weeks for four cycles. Patients then received nivolumab maintenance therapy (480 mg once every 4 weeks) for up to 2 years. The primary end point was progression-free survival, as determined by blinded independent review according to Response Evaluation Criteria in Solid Tumors, version 1.1, and was assessed in the first 550 patients who had undergone randomization. The secondary end point was overall survival, assessed in all patients who had undergone randomization. Overall, 855 patients underwent randomization: 428 were assigned to the experimental group and 427 to the control group. Among the first 550 patients who had undergone randomization (276 in the experimental group and 274 in the control group), the probability of progression-free survival at 12 months was 0.57 in the experimental group and 0.49 in the control group (hazard ratio for disease progression or death, 0.73; 95% confidence interval, 0.57 to 0.94; P = 0.01); 43% of the patients in the experimental group and 36% in the control group had a response. Grade 3 or 4 adverse events occurred in 79% of the patients in the experimental group and in 56% in the control group. Follow-up for overall survival is ongoing. Among patients with previously untreated, advanced renal-cell carcinoma who had intermediate or poor prognostic risk, treatment with cabozantinib plus nivolumab and ipilimumab resulted in significantly longer progression-free survival than treatment with nivolumab and ipilimumab alone. Grade 3 or 4 adverse events were more common in the experimental group than in the control group. (Funded by Exelixis; COSMIC-313 ClinicalTrials.gov number, NCT03937219.).
Funding Information
  • Exelixis

This publication has 18 references indexed in Scilit: