Final results from a phase I trial and expansion cohorts of cabozantinib and nivolumab (CaboNivo) alone or with ipilimumab (CaboNivoIpi) for metastatic genitourinary tumors.

Authors

Andrea Apolo

Andrea B. Apolo

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

Andrea B. Apolo , Daniel da Motta Girardi , Scot Anthony Niglio , Rosa Maria Nadal , Lisa M. Cordes , Seth M. Steinberg , Rene Costello , Jane B Trepel , Sunmin Lee , Min-Jung Lee , Liang Cao , James L. Gulley , Biren Saraiya , Sumanta K. Pal , David I. Quinn , Primo "Lucky" N. Lara Jr., Howard L. Parnes , William L. Dahut , Amir Mortazavi , Donald P. Bottaro

Organizations

National Cancer Institute, National Institutes of Health, Bethesda, MD, National Institutes of Health, Bethesda, MD, Biostatistics and Data Management Section, National Cancer Institute, NIH, Bethesda, MD, Center for Cancer Research, NCI, NIH, Bethesda, MD, Developmental Therapeutics Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, Genetics Branch Center for Cancer Research National Cancer Institute, Bethesda, MD, The National Cancer Institute at the National Institutes of Health, Bethesda, MD, Division of Medical Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, Department of Medical Oncology & Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USC Norris Cancer Hospital, Los Angeles, CA, University of California, Sacramento, CA, National Cancer Institute at the National Institutes of Health, Bethesda, MD, National Cancer Institute, Bethesda, MD, Arthur G. James Cancer Hospital, Ohio State University Wexner Medical Center, Columbus, OH, Center for Cancer Research, Division of Cancer Treatment and Diagnosis, Bethesda, MD

Research Funding

U.S. National Institutes of Health
U.S. National Institutes of Health.

Background: CaboNivo and CaboNivoIpi showed promising efficacy and safety in a dose-escalation phase I study in patients (pts) with metastatic genitourinary (mGU) tumors. We now report the final results from a pooled analysis of the phase I dose-finding and 7 subsequent expansion cohorts. Methods: Pts with mGU tumors in the phase I cohort received 8 escalating doses of CaboNivo or CaboNivoIpi. In the 7 expansion cohorts, pts received the recommended phase II dose for CaboNivo (cabo 40mg qd + nivo 3mg/kg q2wks in 28-day cycles) and for CaboNivoIpi (CaboNivo same dose + ipi 1mg/kg q3wks in 21-day cycles x 4 cycles followed by CaboNivo). The CaboNivo expansion cohorts included pts with urothelial carcinoma (UC); clear cell renal cell carcinoma (RCC), bladder adenocarcinoma (BlaAdeno), and other rare mGU tumors. The CaboNivoIpi expansion cohorts included, UC, RCC, and penile carcinoma (penile). The objectives of the study were to determine the clinical activity, safety and tolerability of both combinations. A secondary objective was the detection of EpCAM+ circulating tumor cells (CTCs). Biomarker correlatives of plasma VEGFA/VEGFR2, PIGF, and inflammatory cytokines will be presented. Results: A total of 120 pts (median age 59; range 20-82) were enrolled: 54 in the phase I and 66 in the dose expansion cohorts. 64 pts received CaboNivo and 56 CaboNivoIpi. Median follow-up was 40.4 months (range 2.2-62.2 months). The ORR for 108 evaluable pts was 38% (95% CI: 28.8-47.8%) with 12 complete responses (CRs) (11.1%) and 29 partial responses (26.9%). The ORRs for the following mGU tumors were: UC 42.4% (n=33) with CR=21.2%; RCC 62.5% (n=16); prostate cancer 11.1% (n=9); germ cell tumor no responses (n=6); BlaAdeno 20% (n=15); penile 44.4% (n=9); bladder squamous 85.7 (n=7); renal medullary 50% (n=2); bladder small cell 33.1 (n=3). The median overall survival for the entire population was 15.9 months (95% CI: 11.6-23.9); 24.9 months (95% CI: 11.8-41.6) for pts with UC (n=39); and 38.6 months (95% CI: 19.4-not estimable) for RCC (n=16). Median duration of response was 22.8 months (95% CI: 18.3-40.1 months) for all pts, 32.1 months [95% CI: 20.3-NE)] for the UC pts and 20.1 months (95% CI: 5.8-NE) for RCC pts. Grade 3 or 4 treatment related adverse events (AEs) occurred in 84% and 80% of pts treated with CaboNivo and CaboNivoIpi pts respectively, and included hypophosphatemia (25% and 16%), lipase elevation (20% and 20%), fatigue (20% and 18%), ALT elevation (5% and 14%), AST elevation (9% and 11%), diarrhea (9% and 11%), and thromboembolic event (11% and 4%). One pt had Grade 5 pneumonitis on CaboNivoIpi. Baseline EpCAM+ CTC count of < 5 vs. > 5, was associated with longer median OS (24.3 vs. 12.3 months p=0.037). Conclusions: CaboNivo and CaboNivoIpi demonstrated promising clinical activity and manageable safety in many mGU histologies including rare tumors. Clinical trial information: NCT02496208

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Abstract Details

Meeting

2021 Genitourinary Cancers Symposium

Session Type

Rapid Oral Abstract Session

Session Title

Rapid Abstract Session: Urothelial Carcinoma and Rare Tumors

Track

Urothelial Carcinoma,Adrenal Cancer,Penile Cancer,Testicular Cancer,Urethral Cancer

Sub Track

Therapeutics

Clinical Trial Registration Number

NCT02496208

Citation

J Clin Oncol 39, 2021 (suppl 6; abstr 3)

DOI

10.1200/JCO.2021.39.6_suppl.3

Abstract #

3

Abstract Disclosures