Cabozantinib outcomes for metastatic renal cell carcinoma at a tertiary NHS hospital in the United Kingdom (UK).

person Guhan Arumugam Shanmugasundaram Norfolk and Norwich University Hospitals NHS Trust, Norwich, United Kingdom info_outline Guhan Arumugam Shanmugasundaram, Emily Holden, Hadeel Al-Husban, Farasat Kazmi, David Maskell, Gaurav Kapur

Authors person Guhan Arumugam Shanmugasundaram Norfolk and Norwich University Hospitals NHS Trust, Norwich, United Kingdom info_outline Guhan Arumugam Shanmugasundaram, Emily Holden, Hadeel Al-Husban, Farasat Kazmi, David Maskell, Gaurav Kapur Organizations Norfolk and Norwich University Hospitals NHS Trust, Norwich, United Kingdom, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom, Norfolk and Norwich University Hospital, Norwich, United Kingdom Abstract Disclosures Research Funding No funding sources reported Background: Kidney cancer remains the seventh most common solid organ cancer in the UK, USA and Europe, with renal cell carcinoma forming most of these cases [1]. In the UK, kidney cancer accounts for 3% of all new cancer diagnoses of which 25–31% present with metastatic RCC (mRCC) at initial diagnosis. [2] Methods: The METEOR trial was used as the comparator for response rates and progression-free survival to evaluate our outcomes. In the METEOR trial, treatment with Cabozantinib was associated with significantly better overall survival (OS) (21.4 months (m) with Cabozantinib vs 16.5m Everolimus), progression-free survival (PFS) (7.4m vs 3.9m), objective response rates (ORR) (17% vs 3%), and an equivalent safety profile when compared to Everolimus, a second-line treatment for patients with advanced renal cell carcinoma. [3] We present the results of Cabozantinib outcomes in the first to third line setting for mRCC at an NHS tertiary hospital. A direct comparison of OS is not feasible, as the METEOR data was for Cabozantinib in the second line. In contrast, Cabozantinib was used in first, second and subsequent line settings according to the NHS funding in our hospital trust. Results: From 16 April 2018 to 13 November 2023, 43 patients with mRCC received Cabozantinib at our NHS trust. Compared to the METEOR study, the median follow-up for our NHS tertiary centre patients was 7.5 m, as opposed to 18.7 m. Comparing the real-world data from our NHS centre with the METEOR trial, the ORR (partial response according to RECIST criteria) was 25% compared to 17%, whilst the PFS was 10.6m vs 7.4m. Interestingly, we observed that patients who had received immunotherapy before Cabozantinib had significantly better PFS (12m OS = 22% vs 0%; Log Rank = 0.03). Grade 3 and above toxicities was 32.5% vs 71% (NHS hospital vs METEOR trial). Conclusions: Overall, Cabozantinib showed better than expected response rates, and the toxicities in our NHS tertiary hospital were less severe than in the METEOR trial. Significantly, we observed that individuals who had received immunotherapy before Cabozantinib had higher survival outcomes. References: 1. U.S. Cancer Statistics Working Group. U.S. Cancer Statistics Data Visualizations Tool, based on 2022 submission data (1999-2020): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute; https://www.cdc.gov/cancer/dataviz, released in November 2023; 2. Cancer Research UK [Internet]. Kidney cancer statistics. Available from: http://www.cancerresearchuk.org/healthprofessional/cancer-statistics/statistics-by-cancer-type/kidney-cancer. [Cited: 2019 Jan 15]; 3. Choueiri, Toni K., et al. "Cabozantinib versus everolimus in advanced renal cell carcinoma (METEOR): final results from a randomised, open-label, phase 3 trial." The Lancet Oncology 17.7 (2016): 917-927.