A recent study was published in JAMA Oncology outlining a retrospective cohort study analyzing cabozantinib as a treatment for renal cell carcinoma that has metastasized to the brain. According to the data, cabozantinib demonstrated significant intracranial activity while maintaining a tolerable safety profile.

About the Study

This retrospective cohort study included a total of 88 RCC patients with brain metastases across 15 institutions. They were divided into two cohorts:

• Cohort A: RCC patients with progressing brain metastases without concomitant brain-directed local therapy
• Cohort B: RCC patients with stable or progressing brain metastases who have received concomitant brain-directed local therapy

These patients were followed for a median of 17 months while being treated with cabozantinib. After analysis, results include:

• Intracranial response rate of 55% in Cohort A and 47% in Cohort B
• Extracranial response rate of 48% in Cohort A and 38% in Cohort B
• Median time to treatment failure of 8.9 months in Cohort A and 9.7 months in Cohort B
• Median overall survival of 15 months in Cohort A and 16 months in Cohort B
• In Cohort A, there were 14 partial responses and three complete responses
  • Ten patients reached stable disease while four experienced progressive disease
• In Cohort B, there were 24 partial responses and one complete response
  • Six patients achieved the best response of primary progressive intracranial disease
  • Overall response rate of 54%
• Intracranial progression rate at six months was 25% in Cohort A and 15% in Cohort B
• 21 patients died in Cohort A and 36 in Cohort B
  • The percentage of patients with intracranial progression who died within three months was 14% between both cohorts
  • No deaths were related to cabozantinib
• By the time of analysis, 82% of patients discontinued treatment
  • 57% due to disease progression, 4% due to patient choice, 11% due to toxic effects, and 10% due to other reasons
• The most common adverse events were nausea, diarrhea, fatigue, and palmar-plantar erythrodysesthesia
  • 15 patients reported grade 3/4 adverse events, most commonly mucositis and fatigue
• Dose reductions were needed for 48 patients

These results are positive, demonstrating that cabozantinib leads to significant intracranial activity in those with RCC brain metastases.

About RCC

RCC is a form of kidney cancer that typically begins with a single tumor in one kidney but easily spreads to the lungs and throughout the body (such as the brain, which is the focus of this study). Symptoms often do not appear until this spread has occurred, which can impact diagnosis and intervention. They include abdominal pain, fatigue, high blood pressure, bloody or discolored urine, weight loss, fever, enlarged testicles, varicose testis vein, and vision abnormalities.

While medical professionals are unsure as to what exactly causes RCC, they do know that there are a number of risk factors. These include smoking and a history of kidney problems. Research has also linked mutations in the TFE 3, PRC, and VHL genes to this cancer. Treatment consists of removing the kidney, bladder, and any necessary surrounding tissue. Other treatment options include Proleukin, chemotherapy, sorafenib, hormone treatments, ablation, and Afinitor.

Find the source article here.