Second-Line Cabozantinib in mRCC

The METEOR trial is an ongoing phase III study assessing the use of cabozantinib versus everolimus as second- or third-line therapy in individuals with metastatic renal cell carcinoma (RCC) who have experienced disease progression following treatment with at least 1 VEGF TKI. Patients in the study are randomized 1:1 to receive 60 mg of cabozantinib daily or 10 mg of everolimus daily. The primary endpoint of METEOR is progression-free survival (PFS), and secondary endpoints include overall survival (OS) and objective response rate.

In April 2015, cabozantinib received a fast track designation from the FDA for patients with advanced RCC who had received 1 prior therapy. In a phase I study in the later line RCC setting, cabozantinib demonstrated a median PFS was 12.9 months and the median OS was 15.0 months.

Cabozantinib is a TKI that targets VEGFR-2, as well as MET and RET, explains Sumanta Kumar Pal, MD. Pal adds that MET may potentially be a bypass mechanism for VEGFR signaling, allowing this agent to be effective following developed resistance. Clinical trials remain important for finding new therapies, particularly in later line settings, where there remains an unmet need, notes Saby George, MD.