Dr. Sherman on Sequencing Cabozantinib and Vandetanib

Eric J. Sherman, MD, Head and Neck Oncology Service, Memorial Sloan-Kettering Cancer Center, discusses the current evidence that is available on the optimal sequencing of vandetanib (Caprelsa) and cabozantinib (XL184) for patients with medullary thyroid cancer (MTC).

Results on the administration of cabozantinib for patients with MTC, from the phase III randomized EXAM trial, were presented at the ASCO annual meeting in June and were the basis for submission to the FDA. This trial showed a significant increase in progression-free survival for cabozantinib over placebo. The trial was designed to allow for an overall survival endpoint; however, data for this endpoint is not yet mature.

Evidence on the exact sequencing of cabozantinib and vandetanib is still early and vague and at this point it is unclear how the two agents should be sequenced, Sherman believes. Evidence from the EXAM trial showed that cabozantinib is effective after progression on vandetanib; however, no evidence is available on the effects of using cabozantinib first.