PracticeUpdate: Haematology & Oncology

Continuing our series capturing the top stories in oncology for 2016, PracticeUpdate Oncology Editorial andAdvisory Boardmembers and contributors, Dr Isabel Cunningham, Dr SumantaKumarPal andDrRafael Fonseca share their toppicks for 2016. Featuredare the CABOSUN trial in renal cell carcinoma, monoclonal antibodies as anti-myeloma therapies, and the impact of minimal residual disease in acute myeloid leukaemia. 2016 TOP STORIES IN ONCOLOGY 3

EDITORIAL Managing Editor Anne Neilson anne.neilson@elsevier.com Editor Carolyn Ng carolyn.ng@elsevier.com Designer Jana Sokolovskaja j.sokolovskaja@elsevier.com SALES Commercial Manager Fleur Gill fleur.gill@elsevier.com Account Manager Linnea Mitchell-Taverner l.mitchell-taverner@elsevier.com

CABOSUN clinical trial By Sumanta Kumar Pal, MD T he renal cell carcinoma top story of 2016 is the CABOSUN clinical trial.

I hope that the CABOSUN results will stimulate enthusiasm for efforts to potentially combine cabozantinib with novel immunotherapeutic agents or other novel classes of drugs.

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he CABOSUN study is a trial led by the Alliance cooperative group. The data were just pre- sented at the European Society for Medical Oncology (ESMO) Congress this year and a fol- low-up was published in the Journal of Clinical Oncology . 1 The study included 157 pa- tients who were randomised to either cabozantinib or sunitinib therapy in the front-line setting. These previously untreated pa- tients all had intermediate- or poor-risk disease as defined by International Metastatic Renal Cell Carcinoma Database Con- sortium criteria. P atients received cabozan- tinib at a standard dose of 60 mg once daily or su- nitinib at 50 mg, 4 weeks on, 2 weeks off. The primary endpoint of this study was progression-free survival, and this endpoint was met with an improvement from 5.6 months to 8.2 months with cabozantinib. There was also a 34% reduction in the rate of progression or death (HR, 0.66). The objective response rate was 46% with cabozantinib versus 18% with sunitinib. It is apparent from assessment of the waterfall plots that a number of patients benefitted from system- ic therapy with cabozantinib in the front-line setting. In my mind, these data represent an important breakthrough for patients with previously untreated metastatic renal cell carcinoma with intermediate- or poor-risk disease. At the present time, there are few options for these patients. Temsirolimus represented a standard of care for

therapy with a checkpoint in- hibitor. I would propose that cabozantinib would represent a reasonable comparator arm, and I hope that the CABOSUN re- sults will stimulate enthusiasm for efforts to potentially com- bine cabozantinib with novel immunotherapeutic agents or other novel classes of drugs. Reference 1. Choueiri TK, Halabi S, Sanford BL, et al. J Clin Oncol [published online November 14, 2016] DOI: 10.1200/JCO.2016.70.7398.

patients with poor-risk disease; however, the overall survival estimated with temsirolimus in the poor-risk setting was only 10.4 months. This is profoundly different from the overall survival estimates closer to 30 months observed in this front- line trial of cabozantinib versus sunitinib. Admittedly, the study populations are different. Having said that, cabozantinib should remain a standard of care in the second-line setting and should also be considered for those patients with intermediate- and poor-risk in the front-line setting. It is curious to note that many of the clinical trials that are being designed currently randomise patients to either sunitinib or a novel combination of immu- notherapeutic strategies, either dual checkpoint inhibitors or combination of VEGF-directed

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Dr Pal is Assistant Professor in the Department of Medical Oncology &

PracticeUpdate provides professional research, expert insights, and education resources in a single online destination. PracticeUpdate content is selected by medical experts in haematology and oncology for its relevance,timeliness,and importance. It isguidedby world-renowned editorial and advisory boards that represent community practitioners and academic specialists with cross-disciplinary expertise. For in-depth insights that matter, discover PracticeUpdate.com today.

Therapeutics Research, and Co-Director of the Kidney Cancer Program, City of Hope, California.

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