Dr Desai on the Implications of the CONTACT-03 Trial in RCC

Arpita Desai, MD, medical oncologist, assistant professor, University of California, San Fransisco (UCSF), UCSF Helen Diller Family Comprehensive Cancer Center, discusses the impact that the findings from the phase 3 CONTACT-03 trial (NCT04338269) had in patients with metastatic renal cell carcinoma (RCC).

At the 2023 International Kidney Cancer Symposium (IKCS), Desai discussed some of the most important studies in the RCC armamentarium that had the potential to change the RCC treatment arena in 2023. The focus of her talk was on the CONTACT-03 trial, which ultimately did not provide positive outcomes. However, Desai states that this investigation still holds significant importance in guiding clinical practices for patients with RCC. The original data were presented by Sumanta Kumar Pal, MD, FASCO, of City of Hope, and colleagues, earlier in 2023, and the findings from this global, multicenter, randomized study were originally published in Lancet, Desai explains.

The trial investigated the combination of cabozantinib (Cabometyx) and atezolizumab (Tecentriq) vs single-agent cabozantinib in patients with RCC who had experienced disease progression on previous immunotherapy, she expands. The primary end points of the trial were progression-free survival (PFS) and overall survival (OS), and important secondary end points included overall response rate, safety, and duration of response, Desai emphasizes.

The CONTACT-03 trial did not meet its prespecified primary end points. There was no discernible difference in PFS between the combination arm and the cabozantinib monotherapy arm, she continues. Likewise, there was no observed OS improvement with the combination compared with cabozantinib monotherapy, Desai says. Notably, the combination arm exhibited no complete responses, and the patients in this arm experienced a significantly higher incidence of severe adverse effects vs those in the monotherapy arm, she highlights.

Overall, these findings underscore the importance of exercising caution when using immunotherapy for patients who have progressed on prior immunotherapy, Desai explains. Until there is solid level 1 evidence indicating the benefits of such an approach in this patient population, it is advisable to refrain from employing immunotherapy in patients who have experienced progression on a previous immunotherapeutic agent, she concludes.