The drug cabozantinib (trade name: Cabometyx) has been approved in Germany since September 2016 for the treatment of advanced renal cell cancer.
Renal cell cancer is the most common cancer of the kidneys. It usually goes unnoticed for a long time as symptoms only occur in people with advanced, larger tumors. Symptoms include pain in the kidney area that may radiate into the back, as well as blood in urine. If renal cell cancer has already grown too much or spread to other organs, surgery to remove it may no longer be an effective treatment.
Some people with advanced renal cell cancer have a mutated protein in their tumor tissue called a vascular endothelial growth factor (VEGF). This mutated protein may contribute to uncontrolled growth of the tumor.
Cabozantinib is used for advanced renal cell cancer if previous treatment targeted at VEGF was unsuccessful. Cabozantinib aims to block the protein in the tumor tissue and inhibit tumor growth.
Cabozantinib is available in tablet form in dosages of 20, 40 and 60 mg. The recommended dose is 60 mg a day. The dosage depends on how well the patient tolerates the drug and on the side effects, and can be adapted individually. The treatment is stopped if the disease still progresses or if very severe side effects arise.
For adults with advanced renal cell cancer who have had treatment aimed at VEGF, the standard treatment options are the drugs everolimus or nivolumab.
In 2017, the Institute for Quality and Efficiency in Health Care (IQWiG, Germany) examined the advantages and disadvantages cabozantinib has for adults with advanced renal cell cancer compared with the standard treatments.
For the purpose of this comparison, the manufacturer provided one study involving 658 participants. Half of the patients received cabozantinib, the other half had treatment with everolimus. The following results were found for them:
What are the advantages of cabozantinib?
- Life expectancy: The results of the study suggest that treatment with cabozantinib can prolong life more than everolimus. Half of the patients who received cabozantinib had died after about 21 months. This happened after only about 17 months in the group that had treatment with everolimus.
- Anemia and pneumonia: For these side effects, the study suggests that cabozantinib has an advantage.
What are the disadvantages of cabozantinib?
- Serious side effects: The study suggests that cabozantinib has a disadvantage here: In half the participants who had treatment with cabozantinib serious side effects already occurred after about 2 months, while it took about 4 months with everolimus.
- The study suggests that Cabozantinib has a disadvantage in terms of diarrhea, too: While half the participants who received cabozantinib experienced diarrhea already within about 2 months, the same was the case with everolimus only after almost 23 months.
- High blood pressure and hand-foot syndrome: The study suggests that cabozantinib has a disadvantage in terms of these side effects, too.
- There was no discernible difference between the treatments in terms of symptoms of the disease and general health.
What remains unanswered?
- The manufacturer did not provide any suitable data concerning health-related quality of life and treatments stopped due to side effects.
This information summarizes the main results of a review produced by the Institute for Quality and Efficiency in Health Care (IQWiG, Germany). The review was commissioned by the German Federal Joint Committee (G-BA) as part of the “early benefit assessment of medications.” On the basis of the review and the hearings received, the G-BA passed a resolution on the added benefit of cabozantinib (Cabometyx).
Institute for Quality and Efficiency in Health care (IQWiG, Germany). Cabozantinib (renal cell carcinoma) – Benefit assessment according to §35a Social Code Book V. Dossier assessment; Commission A17-56. January 11, 2018. (IQWiG reports; Volume 583).
IQWiG health information is written with the aim of helping
people understand the advantages and disadvantages of the main treatment options and health
Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.
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