Clinical Perspectives on the Treatment of Neuroendocrine Tumors - Episode 8
CABINET Trial: Efficacy and Safety Results
Panelists discuss how the CABINET trial enrolled nearly 300 patients with well-differentiated neuroendocrine tumors (NETs) (mostly grade 1-2) who were heavily pretreated, demonstrating cabozantinib’s superiority over placebo with over 8 months progression-free survival vs 3 months, with manageable toxicity and effective dose reduction strategies.
Treatment Gaps and Cabozantinib Development
Before cabozantinib approval, NET treatment options were limited to somatostatin analogs, peptide receptor radionuclide therapy, everolimus, capecitabine-temozolomide, and sunitinib. Unlike aggressive cancers where subsequent therapy utilization drops significantly, patients with NETs frequently receive multiple treatment lines due to their indolent nature and good performance status. This creates unique challenges when patients exhaust standard options while remaining healthy and seeking additional treatments.
The major gap emerged for patients who had progressed through multiple lines yet maintained excellent performance status, forcing clinicians to consider treatments with minimal supporting data like capecitabine-temozolomide for nonpancreatic NETs or investigational agents. The cabozantinib development program addressed this critical unmet need by providing an evidence-based option for heavily pretreated patients who previously faced limited choices.
Overall survival remains challenging to demonstrate in NET trials due to the disease’s indolent nature, relatively rare incidence, and extensive treatment crossover. Patients eventually receive most available therapies, making progression-free survival the primary end point for regulatory approval. The CABINET trial filled this gap by providing robust evidence for an active agent in the postprogression setting.
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