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Blanchet B, Xu-Vuilard A, Jouinot A, Puisset F, Combarel D, Huillard O, Le Louedec F, Thomas F, Teixeira M, Flippot R, Mourey L, Albiges L, Pudlarz T, Joly C, Tournigand C, Chauvin J, Puszkiel A, Chatelut E, Decleves X, Vidal M, Goldwasser F, Oudard S, Medioni J, Vano YA. Exposure-response relationship of cabozantinib in patients with metastatic renal cell carcinoma treated in routine care. Br J Cancer 2024; 130:961-969. [PMID: 38272963 PMCID: PMC10950854 DOI: 10.1038/s41416-024-02585-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Interindividual pharmacokinetic variability may influence the clinical benefit or toxicity of cabozantinib in metastatic renal cell carcinoma (mRCC). We aimed to investigate the exposure-toxicity and exposure-response relationship of cabozantinib in unselected mRCC patients treated in routine care. METHODS This ambispective multicenter study enrolled consecutive patients receiving cabozantinib in monotherapy. Steady-state trough concentration (Cmin,ss) within the first 3 months after treatment initiation was used for the PK/PD analysis with dose-limiting toxicity (DLT) and survival outcomes. Logistic regression and Cox proportional-hazards models were used to identify the risk factors of DLT and inefficacy in patients, respectively. RESULTS Seventy-eight mRCC patients were eligible for the statistical analysis. Fifty-two patients (67%) experienced DLT with a median onset of 2.1 months (95%CI 0.7-8.2). In multivariate analysis, Cmin,ss was identified as an independent risk factor of DLT (OR 1.46, 95%CI [1.04-2.04]; p = 0.029). PFS and OS were not statistically associated with the starting dose (p = 0.81 and p = 0.98, respectively). In the multivariate analysis of PFS, Cmin, ss > 336 ng/mL resulted in a hazard ratio of 0.28 (95%CI, 0.10-0.77, p = 0.014). By contrast, Cmin, ss > 336 ng/mL was not statistically associated with longer OS. CONCLUSION Early plasma drug monitoring may be useful to optimise cabozantinib treatment in mRCC patients treated in monotherapy, especially in frail patients starting at a lower than standard dose.
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Affiliation(s)
- Benoit Blanchet
- Université de Paris, CNRS, INSERM, CiTCoM, U1268, F-75006, Paris, France.
- Biologie du Médicament - Toxicologie, Institut du Cancer Paris CARPEM, Assistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, France.
- Groupe de Pharmacologie Clinique Oncologique GPCO-Unicancer, Paris, France.
| | - Alexandre Xu-Vuilard
- Department of Medical Oncology, Institut du Cancer Paris CARPEM, Assistance Publique Hôpitaux de Paris, Hôpital Georges Pompidou, Paris, France
| | - Anne Jouinot
- Department of Medical Oncology, ARIANE, Institut du Cancer Paris CARPEM, Assistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, France
- Université Paris Cité, Institut Cochin, Inserm U1016, CNRS UMR8104, Paris, France
| | - Florent Puisset
- Groupe de Pharmacologie Clinique Oncologique GPCO-Unicancer, Paris, France
- Oncopole Claudius-Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, 31059, Toulouse, France
| | - David Combarel
- Groupe de Pharmacologie Clinique Oncologique GPCO-Unicancer, Paris, France
- Department of Medical Biology and Pathology, Gustave Roussy, Villejuif, France
- Faculté de pharmacie, Université Paris Saclay, Orsay, France
- Medical School, University of Paris XI, Saclay, France
| | - Olivier Huillard
- Department of Medical Oncology, ARIANE, Institut du Cancer Paris CARPEM, Assistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, France
| | - Félicien Le Louedec
- Groupe de Pharmacologie Clinique Oncologique GPCO-Unicancer, Paris, France
- Oncopole Claudius-Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, 31059, Toulouse, France
| | - Fabienne Thomas
- Groupe de Pharmacologie Clinique Oncologique GPCO-Unicancer, Paris, France
- Oncopole Claudius-Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, 31059, Toulouse, France
- CRCT, Cancer Research Center of Toulouse, Inserm U1037, Université Paul Sabatier, 31037, Toulouse, France
| | - Marcus Teixeira
- Department of Oncological Medicine, Gustave Roussy, Villejuif, France
- Medical School, University of Paris XI Saclay, Saclay, France
| | - Ronan Flippot
- Department of Oncological Medicine, Gustave Roussy, Villejuif, France
- Medical School, University of Paris XI Saclay, Saclay, France
- Laboratoire d'immunomonitoring en oncologie, CNRS3655 & INSERM US23, Université Paris Saclay, Paris, France
| | - Loic Mourey
- Oncopole Claudius-Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, 31059, Toulouse, France
| | - Laurence Albiges
- Department of Oncological Medicine, Gustave Roussy, Villejuif, France
- Medical School, University of Paris XI Saclay, Saclay, France
| | - Thomas Pudlarz
- Department of Medical Oncology, Assistance Publique Hôpitaux de Paris, Hôpital Saint Antoine, Paris, France
| | - Charlotte Joly
- Department of Medical Oncology, Assistance Publique Hôpitaux de Paris, Hôpital Henri Mondor, Université de Paris Est, Créteil, France
| | - Christophe Tournigand
- Department of Medical Oncology, Assistance Publique Hôpitaux de Paris, Hôpital Henri Mondor, Université de Paris Est, Créteil, France
| | | | - Alicja Puszkiel
- Biologie du Médicament - Toxicologie, Institut du Cancer Paris CARPEM, Assistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, France
- Groupe de Pharmacologie Clinique Oncologique GPCO-Unicancer, Paris, France
- Université Paris Cité, Inserm, UMR-S1144, Paris, France
| | - Etienne Chatelut
- Groupe de Pharmacologie Clinique Oncologique GPCO-Unicancer, Paris, France
- Oncopole Claudius-Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, 31059, Toulouse, France
- CRCT, Cancer Research Center of Toulouse, Inserm U1037, Université Paul Sabatier, 31037, Toulouse, France
| | - Xavier Decleves
- Biologie du Médicament - Toxicologie, Institut du Cancer Paris CARPEM, Assistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, France
- Groupe de Pharmacologie Clinique Oncologique GPCO-Unicancer, Paris, France
- Université Paris Cité, Inserm, UMR-S1144, Paris, France
| | - Michel Vidal
- Université de Paris, CNRS, INSERM, CiTCoM, U1268, F-75006, Paris, France
- Biologie du Médicament - Toxicologie, Institut du Cancer Paris CARPEM, Assistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, France
| | - François Goldwasser
- Department of Medical Oncology, ARIANE, Institut du Cancer Paris CARPEM, Assistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, France
| | - Stéphane Oudard
- Department of Medical Oncology, Institut du Cancer Paris CARPEM, Assistance Publique Hôpitaux de Paris, Hôpital Georges Pompidou, Paris, France
- Université de Paris Cité, INSERM U970, PARCC, Paris, France
| | - Jacques Medioni
- Department of Medical Oncology, Institut du Cancer Paris CARPEM, Assistance Publique Hôpitaux de Paris, Hôpital Georges Pompidou, Paris, France
| | - Yann-Alexandre Vano
- Department of Medical Oncology, Institut du Cancer Paris CARPEM, Assistance Publique Hôpitaux de Paris, Hôpital Georges Pompidou, Paris, France
- Université de Paris Cité, UMR_S1138-INSERM, Paris, France
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