Clinical efficacy of cabozantinib plus nivolumab (CaboNivo) and CaboNivo plus ipilimumab (CaboNivoIpi) in patients (pts) with chemotherapy-refractory metastatic urothelial carcinoma (mUC) either naïve (n) or refractory (r) to checkpoint inhibitor (CPI).

Authors

null

Rosa Nadal

National Cancer Institute, National Institutes of Health, Bethesda, MD

Rosa Nadal , Amir Mortazavi , Mark N. Stein , Sumanta K. Pal , Daniel K Lee , Howard L. Parnes , Yang-Min Ning , Lisa M. Cordes , Mohammadhadi H. Bagheri , Ryan Thompson , Christian Mayfield , Seth M. Steinberg , Paul Monk III, Primo Lara Jr., Rene Costello , Piyush K. Agarwal , Donald Bottaro , William L. Dahut , Andrea B. Apolo

Organizations

National Cancer Institute, National Institutes of Health, Bethesda, MD, Arthur G. James Cancer Hospital, Ohio State University Wexner Medical Center, Columbus, OH, Columbia University Medical Center, New York, NY, City of Hope, Duarte, CA, National Cancer Institute at the National Institutes of Health, Bethesda, MD, U.S. Food and Drug Administration, Silver Spring, MD, National Institutes of Health, Bethesda, MD, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, National Cancer Institute, Bethesda, MD, Ohio State University, Columbus, OH, University of California, Davis, Sacramento, CA, Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD

Research Funding

NIH

Background: Preliminaryclinical activity of CaboNivo and CaboNivoIpi has been previously reported for mUC pts and other genitourinary tumors. Here, we report longer follow-up data of CaboNivo and CaboNivoIpi in pts with mUC nCPI and safety and preliminary clinical activity of CaboNivo in mUC rCPI Methods: This phase 1 dose + expansion cohorts study enrolled mUC nCPI (escalating doses of CaboNivo n = 15 and CaboNivoIpi n = 8) and mUC rCPI (Cabo40-Nivo3mg/kg n = 7) pts until progression/unacceptable toxicity. Objectives: Safety, ORR, DOR, PFS and OS. Tumors were assessed for response q8wks (RECIST 1.1). Adverse events (AEs) were graded (G) by NCI-CTCAE v4.0. Results: 30 mUC pts enrolled. Median follow-up: whole cohort: 11.9 months; mUC rCPI: 5.6 months. All G clinical AEs in ≥20% (n = 29): fatigue (83%), diarrhea (72%) and anorexia (62%); laboratory AEs: ALT elevation (55%), AST elevation (48%) and hyponatremia (48%). Common ≥G3 clinical AEs: fatigue (17%), HTN (14%), thromboembolic events (14%); laboratory AEs: lipase elevation (31%), hypophosphatemia (17%), hyponatremia (10%). Immune-related AEs 14% (n = 4): mUC nCPI: CaboNivo: G3 meningitis; G3 pneumonitis; CaboNivoIpi: G3 colitis; mUC rCPI: G2 adrenal insufficiency. For mUC nCPI CaboNivo ORR: 50% (6/12), mDOR: 24.1months(mo) [95% CI: 7.8 mo-not reached (NR)]; mPFS 24.1mo [95% CI:1.6mo-NR] & mOS: NR. For mUC nCPI CaboNivoIpi: ORR: 33% (2/6), mDOR: NR; mPFS 10.1mo [95% CI:1.6 mo-NR] & mOS: NR. For mUC rCPI CaboNivo, ORR: 28% (2/7), SD 57% (4/7) and DOR: 100% at 5mo. Conclusions: Both CaboNivo and CaboNivoIpi are safe and active in mUC nCPI pts, CaboNivo is also active in mUC pts previously treated with immunotherapy, suggesting the addition of Cabo to Nivo may aid in overcoming CPI resistance. Clinical trial information: NCT02496208

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Abstract Details

Meeting

2018 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Genitourinary (Nonprostate) Cancer

Track

Genitourinary Cancer—Kidney and Bladder

Sub Track

Bladder Cancer

Clinical Trial Registration Number

NCT02496208

Citation

J Clin Oncol 36, 2018 (suppl; abstr 4528)

DOI

10.1200/JCO.2018.36.15_suppl.4528

Abstract #

4528

Poster Bd #

354

Abstract Disclosures