Cabozantinib (Cabometyx) as first-line treatment of advanced renal cell cancer

In 2018, the Institute for Quality and Efficiency in Health Care (IQWiG, Germany) wanted to find out whether cabozantinib (trade name: Cabometyx) used as first-line treatment has any advantages or disadvantages for adults with advanced renal cell cancer when compared with the current standard treatments. The manufacturer provided one on-going study that provided at least preliminary answers to some questions.

Renal cell cancer can develop in very different ways: Experts try to predict how the disease will progress as precisely as possible to tell whether a patient is at good, intermediate, or poor risk.  Most of the 157 participants in this study were at intermediate risk.

Half of the patients received cabozantinib, and the other half had treatment with sunitinib. The study showed the following results for these patients:

What are the advantages of cabozantinib?

Life expectancy: Some people with advanced renal cell cancer have higher than normal levels of a protein in the tumor tissue called hepatocyte growth factor receptor, which can be detected immunohistochemically (MET-IHC). The study suggests that cabozantinib has a disadvantage for these people. After 16 months, about half of the people who received sunitinib were still alive. Of those patients who received cabozantinib, half survived for at least 26 months.

There was no difference in other patients.

Serious side effects: The study suggests that cabozantinib has an advantage for women here: Severe side effects occurred in them after about 9 months (median value), while in women who received sunitinib this was the case after about a month already. 

There was no difference here in men: Both groups experienced severe side effects after about 2 to 3 months.

No differences

There was no discernible difference in treatments stopped due to side effects between the treatments.

What remains unanswered?

The manufacturer didn't provide any suitable data about symptoms of the disease and health-related quality of life.