Therapeutics and Clinical Risk Management (Jun 2022)
An Evaluation of Cabozantinib for the Treatment of Renal Cell Carcinoma: Focus on Patient Selection and Perspectives
Abstract
Romain Iaxx,1 Felix Lefort,1,2 Charlotte Domblides,1– 3 Alain Ravaud,1,2 Jean-Christophe Bernhard,2,4 Marine Gross-Goupil1 1Department of Medical Oncology, Hôpital Saint-André, Bordeaux University Hospital, Bordeaux, France; 2Bordeaux University, Bordeaux, France; 3ImmunoConcEpt, CNRS UMR 5164, Bordeaux University, Bordeaux, 33076, France; 4Department of Urology, Hôpital Pellegrin, Bordeaux University Hospital, Bordeaux, FranceCorrespondence: Marine Gross-Goupil, Hôpital Saint-André, 1 rue Jean Burguet, Bordeaux Cedex, 33076, France, Tel +33556795808, Fax +33556795896, Email [email protected]: Cabozantinib is an oral tyrosine kinase inhibitor (TKI) with activity against several receptors involved in the angiogenesis pathway, including vascular endothelial growth factor receptor (VEGFR), c-MET and AXL. The antiangiogenic properties of cabozantinib led to its use as a monotherapy for the treatment of metastatic renal cell cancer (RCC), and quickly resulted in this treatment becoming part of the standard of care for these tumors. Since the advent of immune checkpoint inhibitors (ICIs), new standards of care have emerged in first-line settings, involving dual ICI or ICI–VEGF-TKI (including ICI–cabozantinib) combination treatments, and leading to a more complex algorithm of care. Cabozantinib remains an option in second-line settings and is still a first-line standard of care treatment in cases where the use of ICIs is contraindicated. This review focuses on the selection of patients who may benefit most from cabozantinib therapy, including those with bone and brain metastases and those with a non-clear cell RCC histology. The need to consider disease-related symptoms, comorbidities, age, drug interactions and biomarker analyses in the choice of therapeutic strategy is also highlighted. Finally, the perspectives for the use of cabozantinib in RCC treatment are discussed.Keywords: renal cancer, cabozantinib, patient selection, prognosis, efficacy, safety
