COMMENTARY

Cabozantinib a Possible New Standard in Second-line Metastatic Renal Cell Carcinoma

David L. Graham, MD

Disclosures

June 21, 2016

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Some of the data that have been most impressive to me at the 2016 American Society of Clinical Oncology (ASCO) meeting have been in the treatment of metastatic renal cell carcinoma. There have been two very important things that have come out, as I see it.

First is the use of a drug called cabozantinib for second-line treatment in metastatic renal cell carcinoma. It was compared with another drug, everolimus, which was very commonly used up to this point. In the long-term overall survival results of the METEOR trial,[1] we found that the survival by using cabozantinib was almost twice that seen in the patients who received everolimus. That may go a long way toward making cabozantinib the standard drug as second-line treatment in renal cell carcinoma.

The problem is that we actually have eight or nine different drugs, all of which are approved, in this indication. Now we are really stuck with the question, "Which drug should we use, in which patient, and when?" We do not have a good way to answer that right now. Normally, we would answer that by doing a whole lot of different clinical trials, which would take years and years to do. That may be the way we end up doing it. Now, through a lot of different mechanisms that are starting to come into play, including ASCO's CancerLinQ program, we may be able to take advantage of big data to follow practice and treatment patterns and see how these patients do long-term. That can really revolutionize how we find these answers.

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