Introduction

Cabozantinib (trade name: Cabometyx) has been approved in Germany since September 2016 for the treatment of advanced renal cell cancer in adults who have had treatment before. It has also been approved for first-line treatment since May 2018.

Renal cell cancer is the most common type of kidney cancer. 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, such as the vascular endothelial growth factor (VEGF) or the immunohistochemical hepatocyte growth factor. These mutated proteins may contribute to uncontrolled growth of the tumor.

Cabozantinib aims to block these proteins in the tumor tissue and inhibit tumor growth.

Application

Cabozantinib is available in tablet form in doses 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.

Other treatments

Medications such as bevacizumab with interferon alfa-2a, pazopanib, sunitinib, or temsirolimus are available for patients with advanced renal cell cancer who haven't had treatment before, depending on the outlook for the further course of their disease.

For people who have already had treatment aimed at VEGF, the standard treatment options are everolimus or nivolumab.

Assessment

In 2018, the Institute for Quality and Efficiency in Health Care (IQWiG, Germany) examined the advantages and disadvantages cabozantinib has in the treatment of advanced renal cell cancer compared with the standard treatments.

The manufacturer provided one relevant study each for the following groups:

  • Adults who haven not had treatment: Cabozantinib compared with sunitinib
  • Adults who have had treatment: Cabozantinib compared with everolimus

Learn more

More information

This information summarizes the main results of reviews produced by the Institute for Quality and Efficiency in Health Care (IQWiG, Germany). The reviews were commissioned by the German Federal Joint Committee (G-BA) as part of the “early benefit assessment of medications.” On the basis of the reviews and the hearings received, the G-BA passed a resolution on the added benefit of cabozantinib (Cabometyx).