#GU21: Advancing Therapies for Patients With Metastatic Papillary Kidney Cancer

In today’s episode, Dr. Neeraj Agarwal, medical oncologist and director of the Genitourinary Oncology Program at the University of Utah’s Huntsman Cancer Institute, discusses the SWOG 1500 trial and a potential new standard of care for patients with metastatic papillary renal cell carcinoma.

Transcript

ASCO Daily News: Welcome to the ASCO Daily News podcast. I'm Geraldine Carroll, a reporter for the ASCO Daily News. My guest today is Dr. Neeraj Agarwal, who is a medical oncologist and director of the genitourinary oncology program at the University of Utah Huntsman Cancer Institute.

Dr. Agarwal will discuss a potential new standard of care for patients with metastatic papillary renal cell carcinoma, featured at the 2021 Genitourinary Cancer Symposium. Dr. Agarwal has served in a consulting or advisory role for AstraZeneca, Bristol Myers Squibb, Exelixis, and Merck, among other organizations. His full disclosures and those relating to all of our episodes are available on our transcripts at asco.org/podcasts.

Dr. Agarwal, papillary renal cell carcinoma is an area of great unmet need. The SWOG 1,500 trial explores new therapy for patients with metastatic papillary RCC. What can you tell us about this study, abstract 270?

Dr. Neeraj Agarwal: This study presented by Dr. Monty Pal from the City of Hope sets the standard of care for a rare disease for which there previously was not. So this is a phase II trial originally designed as a four arm randomized study comparing sunitinib to three investigational agents, cabozantinib, crizotinib, and savolitinib. The three investigational agents hit a target called MET, which is often altered in papillary kidney cancer.

The primary endpoint of the trial is progression-free survival, with secondary endpoints of overall survival, objective responses, and adverse events. The accrual in two arms, savolitinib arm and the crizotinib bar was halted early for futility due to poor progression-free survival seen with these agents. This was surprising, actually, given that both are potent and selective MET inhibitors. Since these arms were closed, I will focus on results from the experimental arm with cabozantinib versus sunitinib.

A total of 46 patients were accrued in the control arm, sunitinib, and 44 patients in the experimental arm with cabozantinib. These are relatively large numbers given the rare nature of papillary renal cell carcinoma. The primary endpoint of improved progression-free survival in the cabozantinib arm was reached at 9.2 months versus 5.6 months in this sunitinib arm.

The results are statistically significant, with progression-free survival HR of 0.61 and a p-value of 0.021, which translates into a 40% reduction in disease progression or death with cabozantinib. Adverse events were as expected for these two ages, with 69% versus 72% events occurring in the sunitinib and the cabozantinib arms, respectively. Moving forward, cabozantinib should represent the standard of care for patients with metastatic papillary kidney cancer. And I'd like to add that my colleague, Benjamin Maughan at the Huntsman Cancer Institute will hopefully be carrying these results forward in a clinical trial he and Dr. Monty Pal will be running in SWOG, which will be comparing cabozantinib with and without immunotherapy, so a lot more to come.

ASCO Daily News: Thank you Dr. Agarwal for sharing your insight with us today. I look forward to hearing more of your highlights from the symposium in our next episode of the podcast.

Dr. Neeraj Agarwal: Thank you for inviting me, Geraldine. It's always a pleasure.

ASCO Daily News: And thanks to our listeners for joining us, as well. Please take a moment to rate, review, and subscribe wherever you get your podcasts.

Disclosures: Dr. Neeraj Agarwal

Consulting or Advisory Role:  Pfizer, Medivation/Astellas, Bristol-Myers Squibb, AstraZeneca, Nektar, Lilly, Bayer, Foundation One Inc, Pharmacyclics, Foundation Medicine, Astellas Pharma, Exelixis, Merck, Novartis, Eisai, Seattle Genetics,  EMD Serono, Janssen Oncology, AVEO, Calithera Biosciences, MEI Pharma, Genentech

Research Funding (Institution): Bayer, Bristol-Myers Squibb, GlaxoSmithKline, Takeda, Novartis, Pfizer, BN ImmunoTherapeutics, Exelixis, TRACON Pharma, Rexahn Pharmaceuticals, Amgen, AstraZeneca, Active Biotech, Bavarian Nordic, Calithera Biosciences, Celldex, Eisai, Genentech, Immunomedics, Janssen, Merck, Newlink Genetics, Prometheus, Sanofi

Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.