Bladder Cancer Update & Renal Cell Cancer Update, 2017 (Video Program)Side-effect profile and dosing of cabozantinib in advanced RCC
1:39 minutes.
TRANSCRIPTION:
DR LOVE: I’m curious too in terms of your perception of tolerability of cabozantinib. I’ve heard mixed things. I remember hearing about this originally in prostate cancer. I know there’s an issue of dose. Can you kind of just tell me your gestalt feeling, first of all, from the clinical research data as well as from your clinical experience about how cabo’s tolerability compares quality wise with the other TKIs and how easy or difficult it is to use in your opinion? DR RINI: I think — so we participated in the registration trial and have started to use it off study. So we have some experience — not extensive, but some. I think it is a tougher drug. And I think one of the issues is that — it kind of gets back to that titration question. So in the METEOR study, 60% of patients had to go down in dose from the starting 60 mg. So it tells you that most patients aren’t going to tolerate the initial dose, and I think half of those patients had to even go down to 20. So because of its long half-life and just the tablet size, it’s not as titratable as some other drugs, like axitinib. And I think that would be helpful for that drug, to be able to be titrated a bit more. Because we don’t know what the right dose is for patients. And starting everybody at a toxic dose may not make sense, either. Obviously, these patients are third and fourth line, so they’re a little bit beat up, unlike front-line patients. So their ability to withstand that initial toxic dose is, I think, probably a little bit less. DR LOVE: What are the major tolerability issues with cabo? DR RINI: Similar to other TKIs — fatigue and diarrhea, I think, predominately, mucositis, LFTs, the other things that we commonly see, blood pressure. I think probably fatigue and diarrhea are the biggest. And it’s from a day-to-day patient standpoint. |