GU Cancers 2019 | Analysis of OS based on early tumor shrinkage in the phase III METEOR study

Ignacio Duran

Ignacio Duran, MD, PhD, of the Hospital Universitario Virgen del Rocío, Seville, Spain, speaks at the 2019 Genitourinary Cancers Symposium, held in San Francisco, CA. He describes the rationale, design, results and conclusion of this important study in renacl cell carcinoma.

Transcript (edited for clarity):

Well, the METEOR study was a randomized phase III trial that I think answer a very important question. It was a study where cabozantinib, which is an oral tyrosine kinase inhibitor, was tested against everolimus in patients with metastatic renal cell carcinoma who had progressed to previous therapy. So METEOR, that was already communicated in the past and has been published, with a recent update a couple of years ago demonstrated that cabozantinib provides a significant benefit in terms of overall survival response rate and progression-free survival in those patients.

So METEOR basically defined one of the standards for second-line treatment in patients with metastatic renal cell carcinoma. Having said that, what we have presented here at this ASCO GU 2019, is an analysis where we try to see whether the overall survival of the patients in the METEOR study could be somehow determine by what we call early tumor shrinkage.

What is early tumor shrinkage? Early tumor shrinkage means a reduction in the sum of the longest diameters of the target lesions at the first scan that we do once therapy has been initiated. So what we did in this study is dividing the population of patients in three groups, those patients who had achieved an early tumor shrinkage that was equal or greater to 30%, another group was patients who achieved any degree of tumor shrinkage. And the third group was those patients who did not achieve any tumor shrinkage at the first scan.

Once we had divided the patients in those three groups, we tried to correlate to see the correlation of those different degrees of tumor shrinkage with survival. And what we saw is that patients that had a greater than 30% equal or greater than 30% early tumor shrinkage and were treated with cabozantinib, had a longer survival. The same thing happened with patients that had any degree of early tumor shrinkage. They had a longer survival compare with everolimus. However, in the patients who at the first CT scan had not achieved any tumor shrinkage, survival was similar to the experimental arm or to the comparator arm, everolimus.

So you’d say, okay, what is the conclusion of all of these data? Well, the message to take home is it looks like those patients who achieved any degree of shrinkage at the first CT scan, that could predict a better outcome. Those patients are going to do better in the future. So it’s probably a good tool for the physician, it is some critical information for the physician that can help estimating what is going to be, let’s say, the performance or the final outcome of your patients with metastatic kidney cancer.

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