ASCO GU 2024: Cabozantinib Plus Atezolizumab Combination Therapy Effective for mCRPC Patients
Radiographic progression-free survival 6.3 months among those receiving the combination therapy
TUESDAY, Jan. 30, 2024 (HealthDay News) -- Tyrosine kinase inhibitor cabozantinib (C) plus programmed cell death protein 1 inhibitor atezolizumab (A) can significantly improve the prognoses of patients with metastatic castration-resistant prostate cancer (mCRPC) that has progressed with prior novel hormonal therapy, according to a study presented at the American Society of Clinical Oncology Genitourinary Cancers Symposium, held from Jan. 25 to 27 in San Francisco.
Neeraj Agarwal, M.D., of the Huntsman Cancer Institute at the University of Utah in Salt Lake City, and colleagues conducted the phase 3 study CONTACT-02, in which 507 patients with mCRPC and extra pelvic nodal or visceral metastasis were randomly assigned (1:1) to receive either C+A (253 patients) or a second round of novel hormonal therapy (254 patients; control group). Patients were followed for a median of 12 months. Baseline and clinical characteristics were similar between the groups, with liver metastasis occurring in 25 percent of patients receiving C+A and 26 percent of controls.
The researchers found that patients in the C+A group had longer radiographic progression-free survival compared with the control group (6.3 versus 4.2 months; hazard ratio [HR], 0.65; 95 percent confidence interval [CI], 0.50 to 0.84; P = 0.0007), including in subgroups with liver metastasis (6.0 versus 2.1 months; HR, 0.47; 95 percent CI, 0.30 to 0.74) or prior docetaxel treatment for metastatic castration-sensitive prostate cancer (8.8 versus 4.1 months; HR, 0.55; 95 percent CI, 0.32 to 0.96). The C+A group had higher rates of disease control and objective response among patients with six months or more of follow-up (72.8 and 13.6 percent, respectively) versus the control group (54.5 and 4.2 percent).
The C+A group experienced more treatment-emergent adverse events (TEAEs) than the control group (97 versus 87 percent). Grade 3 and 4 adverse events occurred in 48 percent of the C+A group versus 23 percent of the control group, with the most common being hypertension (7 percent), anemia (6 percent), diarrhea (4 percent), and fatigue (4 percent). TEAEs subsequently led to 16 percent of patients in the C+A group discontinuing treatment versus 15 percent of the control group.
“Metastatic castration-resistant prostate cancer remains a fatal disease, [and patients] with visceral metastasis fare even more poorly, particularly those with liver metastases, with a median overall survival of less than 14 months,” Agarwal said in a press release. “This patient population constituted nearly a quarter of the CONTACT-02 patient population and experienced a magnitude of benefit consistent with that seen in the overall study population.”
Several authors disclosed financial ties to the pharmaceutical industry, including Exelixis, Inc., which funded the study.
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