On February 8, 2021 Ipsen (Euronext: IPN; ADR: IPSEY) reported the first presentation of new analyses from the pivotal Phase III CheckMate -9ER trial demonstrating clinically meaningful, sustained efficacy benefits as well as quality of life improvements with the combination of Cabometyx (cabozantinib) and Opdivo (nivolumab) compared to sunitinib in the first-line treatment of advanced renal cell carcinoma (RCC) (Press release, Ipsen, FEB 8, 2021, View Source;9ER-trial-of-Cabometyx%C2%AE-in-Combination-with-Opdivo%C2%AE-Showed-Significantly-Improved-QoL-Benefits-and-Sustained-Superior-Efficacy-Versus-sunitinib-in-Patients-Living-with-aRCC [SID1234574753]).1 These data will be presented in two posters at the virtual American Society of Clinical Oncology (ASCO) (Free ASCO Whitepaper) 2021 Genitourinary Cancers Symposium (ASCO GU) from 11 – 13 February 2021 and featured in the Poster Highlights Session on 13 February 2021 from 9:00 a.m. – 9:45 a.m. EDT.4
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In a new analysis from the CheckMate -9ER trial (Abstract #308) with a median follow-up of two years (23.5 months), Cabometyx in combination with Opdivo continued to show superior progression-free survival (PFS), objective response rate (ORR) and overall survival (OS) versus sunitinib, with a low rate of treatment-related adverse events (TRAEs) leading to discontinuation.1 No new safety signals were identified with extended follow-up. Across the full study population, the combination doubled median PFS (17.0 months vs. 8.3 months, respectively; HR 0.52; 95% CI: 0.43 to 0.64), the trial’s primary endpoint, compared to sunitinib. The ORR indicated that nearly twice as many patients responded to Cabometyx in combination with Opdivo vs. sunitinib (54.8% vs. 28.4) and the combination maintained improvements in OS, demonstrating a 34% reduction in the risk of death compared to sunitinib (HR: 0.66; 95% CI: 0.50 to 0.87). In an exploratory analysis, the combination was associated with a disease control rate (including complete response, partial response and stable disease) of 88.2% vs. 69.9% with sunitinib and a complete response rate of 9.3% compared to 4.3% with sunitinib. Among patients treated with Cabometyx in combination with Opdivo, 6.6% discontinued both agents due to TRAEs, 9.7% discontinued Opdivo only and 7.2% discontinued Cabometyx only.1
In an exploratory subgroup analysis of 75 patients with sarcomatoid features, the combination of Cabometyx with Opdivo showed benefit in this population typically associated with a poor prognosis, reducing the risk of death by 64% vs. sunitinib (HR 0.36; 95% CI: 0.17 to 0.79) and demonstrating both superior PFS (10.3 months vs. 4.2 months) and ORR (55.9% vs. 22.0%).1
"There is a continued need for new therapies that show benefit across subgroups of patients with advanced renal cell carcinoma," said Robert Motzer, M.D., Kidney Cancer Section Head, Genitourinary Oncology Service, and Jack and Dorothy Byrne Chair in Clinical Oncology, Memorial Sloan Kettering Cancer Center. "In CheckMate -9ER, nivolumab in combination with cabozantinib doubled progression-free survival, increased overall survival and response rate and, in an exploratory analysis, showed impressive disease control, and these promising efficacy results were sustained with extended follow-up. Also, of note, patients in this study reported significant quality of life improvements, which are important for patients undergoing treatment for this challenging disease"
In a second analysis from the CheckMate -9ER trial (Abstract #285) conducted with 18.1 months of median follow-up, patients treated with the combination of Cabometyx and Opdivo reported statistically significant health-related quality of life (HRQoL) benefits.2 Treatment with Cabometyx in combination with Opdivo was associated with a lower treatment burden, decreased the risk of confirmed deterioration in HRQoL and a reduction of disease-related symptoms compared to sunitinib. These exploratory outcomes were measured using Functional Assessment of Cancer Therapy Kidney Symptom Index-19 (FKSI-19), a quality of life tool specific to kidney cancer, and EQ-5D-3L instruments.2
"As the advances in treatments for kidney cancer transform outcomes for patients, the goals of therapy have expanded from increasing survival to improving quality of life," said Dr. Cristina Suárez, Medical Oncologist at the Vall d´Hebron University Hospital, Barcelona, Spain and a lead investigator on the Phase III CheckMate -9ER trial. "The additional analyses presented at ASCO (Free ASCO Whitepaper) GU mean that physicians treating people living with advanced renal cell carcinoma can consider this combination at diagnosis as a first-line option to improve patient outcomes and significantly reduce the risk of deterioration in health-related quality of life scores for their patients. This, in addition to the extended follow-up outcomes data including patients with sarcomatoid features, point to this combination becoming an important treatment approach."
Cabometyx in combination with Opdivo is under review with health authorities globally following the combination’s approval for the first-line treatment of advanced RCC by the U.S. Food and Drug Administration (FDA) in January 2021.
"We’re pleased to share these positive results at ASCO (Free ASCO Whitepaper) GU, building on the growing body of data for the use of Cabometyx in first- and second-line settings. These data further support the importance of research investigating outcomes which really matter to patients," said Prof. Dr. Steven Hildemann, Executive Vice President, Chief Medical Officer, Head of Global Medical Affairs and Patient Safety, Ipsen. "The validations of the type II variation applications to the European Medicines Agency (EMA) for Cabometyx in combination with Opdivo last year brought this new combination regimen one step closer to the previously untreated kidney cancer patient population. Despite recent advances, these patients remain in need of more therapeutic options that extend survival and improve quality of life."
A further notable presentation at ASCO (Free ASCO Whitepaper) GU evaluated the use of Cabometyx versus other TKIs after CPI treatment in the real-world management of patients with metastatic renal cell carcinoma (mRCC) (Abstract #293).3
A retrospective observational cohort study evaluating outcomes associated with Cabometyx or other TKIs (axitinib, lenvatinib, pazopanib, sorafenib, sunitinib) in patients with mRCC following CPI treatment3
Cabometyx (n = 187)
Other TKI (n=60)
p value
6-month response rate (RR6months, primary)
50.8%
33.3%
<0.001
Overall response rate (ORR)
53.5%
38.3%
0.041
Overall survival (OS) (95% CI)
6 months
81.9 (75.5, 86.8)
75.1 (61.5, 84)
0.765
12 months
61.5 (53.5, 68.4)
59.6 (44.7, 71.8)
18 months
51.7 (43.1, 59.6)
45.9 (29.6, 60.7)
Time to treatment discontinuation (TTD, median months)
6.2
3.1
0.015
Dose reductions
47.1%
41.7%
0.466
Discontinuation due to adverse events (AEs)
31.3%
40.4%
Findings from the study suggest that Cabometyx is an effective and well tolerated option, associated with a significantly higher response rate and a lower discontinuation rate versus other TKIs included in the study, after treatment with CPIs.3
Follow Ipsen on Twitter via @IpsenGroup and keep up to date with ASCO (Free ASCO Whitepaper) GU Symposium news and updates by using the hashtag #GU21.
About renal cell carcinoma
There are over 400,000 new cases of kidney cancer diagnosed worldwide each year.5 Of these, renal cell carcinoma (RCC) is the most common type of kidney cancer, accounting for approximately 90% of cases.6,7 It is twice as common in men, and male patients account for over two thirds of deaths.5 If detected in the early stages, the five-year survival rate is high, but for patients with advanced or late-stage metastatic RCC the survival rate is much lower, around 12%, with no identified cure for this disease.8,9
About the CheckMate -9ER trial
CheckMate -9ER is an open-label, randomized, multi-national Phase III trial evaluating patients with previously untreated advanced or metastatic RCC. A total of 651 patients (23% favorable risk, 58% intermediate risk, 20% poor risk; 25% PD-L1 ≥1%) were randomized to Cabometyx plus Opdivo (n = 323) versus sunitinib (n = 328). The primary endpoint is progression-free survival (PFS). Secondary endpoints include overall survival (OS) and objective response rate (ORR). The primary efficacy analysis is comparing the doublet combination versus sunitinib in all randomized patients. The trial is sponsored by Bristol Myers Squibb and Ono Pharmaceutical Co and co-funded by Exelixis, Ipsen and Takeda Pharmaceutical Company Limited.
About Cabometyx (cabozantinib)
Cabometyx is currently approved in 54 countries, including in the European Union, the U.S., the U.K., Norway, Iceland, Australia, Switzerland, South Korea, Canada, Brazil, Taiwan, Hong-Kong, Singapore, Macau, Jordan, Lebanon, Russian Federation, Ukraine, Turkey, United Arab Emirates, Saudi Arabia, Serbia, Israel, Mexico, Chile, Panama and New Zealand for the treatment of advanced RCC in adults who have received prior VEGF-targeted therapy; in the European Union, the U.K., Norway, Iceland, Canada, Australia, Brazil, Taiwan, Hong Kong, Singapore, Jordan, Russian Federation, Turkey, United Arab Emirates, Saudi Arabia, Israel, Mexico, Chile, Panama and New Zealand for previously untreated intermediate- or poor-risk advanced RCC; and in the European Union, the U.S., the U.K., Norway, Iceland, Canada, Australia, Switzerland, Saudi Arabia, Serbia, Israel, Taiwan, Hong Kong, South Korea, Singapore, Jordan, Russian Federation, Turkey, United Arab Emirates, Ukraine, Lebanon and Panama for HCC in adults who have previously been treated with sorafenib.
The detailed recommendations for the use of Cabometyx are described in the Summary of Product Characteristics (SmPC) and in the U.S. Prescribing Information (PI).
Cabometyx is marketed by Exelixis, Inc. in the United States and by Takeda Pharmaceutical Company Limited in Japan. Ipsen has exclusive rights for the commercialization and further clinical development of Cabometyx outside of the U.S. and Japan. Cabometyx is a registered trademark of Exelixis, Inc.