Nivolumab plus cabozantinib versus sunitinib for first-line treatment of advanced renal cell carcinoma: extended follow-up from the phase III randomised CheckMate 9ER trial

BACKGROUND

Nivolumab plus cabozantinib (NIVO + CABO) was approved for first-line treatment of advanced renal cell carcinoma (aRCC) based on superiority versus sunitinib (SUN) in the phase III CheckMate 9ER trial (18.1 months median survival follow-up per database lock date); efficacy benefit was maintained with an extended 32.9 months of median survival follow-up. We report updated efficacy and safety after 44.0 months of median survival follow-up in intent-to-treat (ITT) patients and additional subgroup analyses, including outcomes by International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) prognostic risk score.

PATIENTS AND METHODS

Patients with treatment-naïve aRCC received NIVO 240 mg every 2 weeks plus CABO 40 mg once daily or SUN 50 mg for 4 weeks (6-week cycles), until disease progression/unacceptable toxicity (maximum NIVO treatment, 2 years). Primary endpoint was progression-free survival (PFS) per blinded independent central review (BICR). Secondary endpoints were overall survival (OS), objective response rate (ORR) per BICR, and safety and tolerability.

RESULTS

Overall, 323 patients were randomised to NIVO + CABO and 328 to SUN. Median PFS was improved with NIVO + CABO versus SUN [16.6 versus 8.4 months; hazard ratio (HR) 0.59; 95% confidence interval (CI) 0.49-0.71]; median OS favoured NIVO + CABO versus SUN (49.5 versus 35.5 months; HR 0.70; 95% CI 0.56-0.87). ORR (95% CI) was higher with NIVO + CABO versus SUN [56% (50% to 62%) versus 28% (23% to 33%)]; 13% versus 5% of patients achieved complete response, and median duration of response was 22.1 months versus 16.1 months, respectively. PFS and OS favoured NIVO + CABO over SUN across intermediate, poor and intermediate/poor IMDC risk subgroups; higher ORR and complete response rates were seen with NIVO + CABO versus SUN regardless of IMDC risk subgroup. Any-grade (grade ≥3) treatment-related adverse events occurred in 97% (67%) versus 93% (55%) of patients treated with NIVO + CABO versus SUN.

CONCLUSIONS

After extended follow-up, NIVO + CABO maintained survival and response benefits; safety remained consistent with previous follow-ups. These results continue to support NIVO + CABO as a first-line treatment for aRCC.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03141177.

Relation between vascular endothelial growth factor receptor (VEGFR) in tumor sample and response rate in patients with cervical cancer treated with chemo-radiotherapy

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Background: The vascular endothelial growth factor (VEGF) and their receptors play a fundamental role in the regulation of the angiogenesis and linfoangiogenesis. This study examined the relation between levels of expression of the VEGFR with the rate of response in patients (pts) with cervical cancer treated with chemo-radiotherapy-brachytherapy with cisplatinum. Methods: Clinical records of 30 women with their pathology were analyzed. The expression of the VEGFR was evaluated by inmunohistochemestry (IHQ-) by a pathologists committee and It was classified in 4 categories according percentage of tumor cells cytoplasm marked: 0 = 0% / 1=< 25% / 2=<26%-50% and 3 = > 50%. In order to correlate the VEGFR expression with response rate, patients were classified in 2 groups: lower level of expression (VEGFR 0–1), and high level of expression (VEGFR 2–3). In a second analysis we discriminated those with VEGFR expression 3 ant the rest of the group. The evaluation of the tumor response was made by clinical examination and magnetic nuclear resonance (RNM). We used Fisher exact test for statistical analysis Results: Median age: 47 years (r: 27 - 69). Pts with VEGFR 0 =2 (6.66%) pt with 1,2,3 VEGFR =28 (93.33%)(p:<0,001) . Objective respnse rate (OR) in pts with low expression of VEGFR was 90.9%, OR rate for pts with high levels of expression VEGFR was 56.97% (p: 0,52). The OR rate for pts with VEGFR 3 OR was 28.57% and for pats with VEGFR 0,1,2 was 69.56% (p:0,035) Conclusions: We observed that 93.33% of pts expresed VEGFR. OR rate was higher among pts. with lower expression compared with pts. of higher level of expression. These results, although in a small group of patients, stimulate investigation of anti angiogenic therapies in cervical cancer.

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