Dr Vaishampayan on Cabozantinib Plus Atezolizumab in RCC

Ulka Nitin Vaishampayan, MBBS, director, Phase I Program, Rogel Cancer Center, University of Michigan, discusses findings from the phase 3 CONTACT-03 trial (NCT04338269) in patients with renal cell carcinoma (RCC).

Data from the primary analysis of CONTACT-03, which were presented at the 2023 ASCO Annual Meeting, showed that the addition of atezolizumab (Tecentriq), a PD-L1 inhibitor, to cabozantinib (Cabometyx), a TKI, did not improve clinical outcomes compared with cabozantinib alone in patients with metastatic RCC who had progressed during or after prior therapy with immune checkpoint inhibitors, Vaishampayan says. The median progression-free survival (PFS) was 10.6 months (95% CI, 9.8-12.3) with the combination vs 10.8 months (95% CI, 10.0-12.5) with cabozantinib alone. The 12-month PFS rates were 44% (95% CI, 38%-50%) and 48% (95% CI, 42%-54%) in the combination and cabozantinib monotherapy arms, respectively. The stratified hazard ratio for PFS was 1.03 (95% CI, 0.83-1.28; P = .784).

In CONTACT-03, 63.1% and 61.4% of patients in the combination and monotherapy arms had received 1 prior VEGF TKI, respectively, and 1.5% and 1.9% of these patients had received 2 prior VEGF TKIs, respectively. In patients who had received no prior VEGF TKI treatment, the median PFS was 9.7 months and 10.4 months in the combination and monotherapy arms, respectively (HR, 1.02; 95% CI, 0.71-1.46). In patients who had received 1 prior VEGF TKI, the median PFS was 10.6 months in the combination arm vs 11.7 months in the monotherapy arm (HR, 1.06; 95% CI, 0.80-1.39). In patients who had received 2 prior VEGF TKIs, the median PFS was 6.7 months and 11.3 months in the combination and monotherapy arms, respectively (HR, 1.64; 95% CI, 0.36-7.47).

Despite the lack of clinical benefit with atezolizumab plus cabozantinib in this trial, CONTACT-03 is the first large, randomized clinical trial to show the efficacy of a TKI in patients who have received prior immune checkpoint inhibitors, Vaishampayan concludes.