Robert A. Figlin, MD, Discussed How New Findings Support Cabozantinib as Second-Line Standard in RCC

At the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting, CancerNetwork® spoke with Robert A. Figlin, MD, Deputy Director of Cedars-Sinai Cancer and Genitourinary Tumor Chair of the Editorial Board of the journal ONCOLOGY®, about findings from the CANTATA trial (NCT03428217) of telaglenastat versus placebo, both in combination with cabozantinib (Cabometyx), as therapy for patients with renal cell carcinoma receiving therapy after immune checkpoint inhibitors or antiangiogenic therapies.

Despite the trial failing to improve efficacy in this setting, the investigators concluded that the data serve to enhance what’s already known about cabozantinib in the second-line setting for RCC and establishes the agent as the drug of choice for these patients.

Transcript:

The importance of CANTATA is several fold. First, it [explores] a novel mechanism of action [of] trying to inhibit enzymes that are part of the Krebs cycle. It is a new approach to kidney cancer. And this happens to be a glutaminase inhibitor. I don’t think that this single trial should deter us from asking other important questions. It was a very well-designed trial that asked the question of the glutaminase inhibitor with cabozantinib at standard dose versus cabozantinib and placebo.

The clear message is that this glutaminase inhibitor in this disease at this moment is not shown to be effective or more effective than standard-agent cabozantinib. The other thing that it shows us—[since] eligibility included [patients with] both prior antiangiogenic agents as well as prior immuno-oncology [IO] agents, like [ipilimumab (Yervoy)/nivolumab (Opdivo)]—is a real-world experience that now shows cabozantinib is really the drug of choice when a person has failed prior IO or prior antiangiogenic therapy. Now with progression-free survivals of 9 months, we can really see benefits overall in all populations and a hint of maybe a little bit more activity in the prior IO patient populations. Even so, I think cabozantinib is now a drug that hits both VEGFR, MET, and AXL, and is known to be safe and effective in the prior IO and [tyrosine kinase inhibitor] regime and without any unacceptable, new adverse events. I think when a physician in practice is thinking about what to do in the second line, cabozantinib should be at the top of the list for them to consider.

References

Tannir NM, Agarwal N, Porta C, et al. CANTATA: Primary analysis of a global, randomized, placebo (Pbo)-controlled, double-blind trial of telaglenastat (CB-839) + cabozantinib versus Pbo + cabozantinib in advanced/metastatic renal cell carcinoma (mRCC) patients (pts) who progressed on immune checkpoint inhibitor (ICI) or anti-angiogenic therapies.

J Clin Oncol. 2021;39(suppl 15):4501. doi:10.1200/JCO.2021.39.15_suppl.4501