New drug cabozantinib for treating advanced kidney cancer under NICE review.

New drug cabozantinib, for use in treating advanced kidney cancer (approved by the FDA in the USA), is currently in the process of being appraised by NICE for use in the treatment of advanced kidney cancer. Kidney cancer is classed as advanced once it has metastasised to another area of the body and the current NICE recommended treatment is illustrated below:
Currently :                  
recommended as:     Name of drug              Type of drug                                          Action
1st line treatment     – pazopanib     —      Tyrosine kinase inhibitor   —   Inhibits tumour cell growth and blood

vessel formation

1st line treatment     –  sunitinib       —      Tyrosine kinase inhibitor    —   Inhibits tumour cell growth and blood

vessel formation

2nd line treatment    –      axitinib     —      Tyrosine kinase inhibitor    —   Inhibits tumour cell growth and

blood vessel formation

Everolimus and nivolumab are currently being appraised by NICE at the moment:

Under review by NICE –  nivolumab –  Monoclonal antibody, PD-1 receptor  –  Increases the immune system’s

ability to attack tumour cells.

Under review by NICE –  everolimus – mTOR inihibitor                                  –  Stops or slows cancer growth

 
Cabozantinib is another tyrosine kinase inhibitor that is being appraised by NICE following successful clinical trial results. Cabozantinib acts in a similar way to the other TKI’s but has been shown to target c-MET and VEGFR2 tyrosine kinases.

The results of the phase III clinical trial look promising. Cabozantinib increased the overall survival of people with advanced kidney cancer to an average of 20.1 months compared to 12.1 months with everolimus. The period of time before the disease progressed (progression free survival) was 7.4 months with cabozantinib compared to 2.7 months with everolimus. ¹

The drug is currently available for use in America and is being appraised here for use as a 2^nd line treatment (used after another TKI treatment). Kidney Cancer UK will be submitting comments on the NICE appraisal of cabozantinib and the appraisal result is due to be released in June 2017.

1.Choueiri et al, 2015. Cabozantinib versus Everolimus in Advanced Renal-Cell Carcinoma. N Engl J Med 2015; 373:1814-1823