Kidney Cancer UK is delighted that National Institute for Health and Care Excellence (NICE) has recommended the drug cabozantinib (Cabometyx) be made available to advanced kidney cancer patients throughout the NHS. The drug, which was recommended for use in Scotland last month by the Scottish Medicines Consortium (SMC), will now also be recommended for patients in England and Wales, on the NHS.
The NHS currently funds a handful of front line drugs for advanced kidney cancer and this number is gradually increasing. The addition of cabozantinib to the drugs available gives patients more options. Many patients require fourth and fifth line treatments. The aim of making kidney cancer a chronic, rather than a life-limiting disease, will become more of a reality as the number of treatments and improved responses to these drugs increase. As different people respond better to some treatments than others – both in terms of tumour response and severity of side-effects – it is important to find the right drugs for the individual; more options help in this process.
Cabozantinib; a summary of the pharmacology, clinical trial and side-effects.
Cabozantinib is a tyrosine kinase inhibitor (TKI) that targets vascular endothelial growth factor receptor (VEGFR), like many of the drugs which are currently recommended for advanced kidney cancer. However, it also targets MET and AXL receptors, which is an interesting development. These receptors have been implicated in metastatic kidney cancer and the development of resistance to this type of drug, so this treatment may have added benefits for some patients.
The results of the cabozantinib phase III METEOR 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 These results show cabozantinib to be effective and provide value when used as a second-line treatment after prior drug treatment has failed.
Cabozantinib has similar side-effects to other TKI’s which are already approved by NICE. Adverse effects are managed by reducing the dose and 9% of patients discontinued the drug during the trial. A once-a -day tablet dosing protocol is easy to fit around daily life.
- Choueiri et al, 2015. Cabozantinib versus Everolimus in Advanced Renal-Cell Carcinoma. N Engl J Med 2015; 373:1814-1823