GU Cancers 2024 | CONTACT-2: cabozantinib and atezolizumab in mCRPC
Kim Chi
• 25 Jan 2024
Kim Chi, MD, BC Cancer Vancouver Centre, Vancouver, Canada, provides an overview of the Phase III CONTACT-2 trial (NCT04446117) of cabozantinib and atezolizumab in patients with metastatic castration-resistant prostate cancer (mCRPC). The primary objective, radiographic progression-free survival (rPFS), was met, but overall survival was not met. Patient-reported outcomes were additionally not improved. This interview took place at the ASCO GU Cancers Symposium 2024 in San Francisco, CA.
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Transcript (edited for clarity)
TheCONTACT-2 study is a randomized Phase III trial that was presented by Dr Agarwal, and it’s the first analysis of the study. It looked at a combination of cabozantinib plus atezolizumab versus an ARPI switch, and patients that had progressed after an AR pathway inhibitor...
TheCONTACT-2 study is a randomized Phase III trial that was presented by Dr Agarwal, and it’s the first analysis of the study. It looked at a combination of cabozantinib plus atezolizumab versus an ARPI switch, and patients that had progressed after an AR pathway inhibitor. The main finding was that the radiographic progression free survival was improved for the cabozantinib and atezolizumab arm. The median radiographic progression free survival was 6.3 months versus about 4.2 months in the patients that had ARPI switch. So it is a positive study, but there are a number of limitations of this study that I think we need to consider before we would actually try to recommend this kind of therapy. Number one, the radiographic progression free survival duration of benefit is actually pretty modest, it was only two months, and on the study scans were being done roughly every two months. So really that means the change was from one scan to the next, so that’s of arguable clinical significance as well. There was no other benefits, overall survival wasn’t improved and patient reported outcomes like time to pain, deterioration or quality of life deterioration weren’t improved either. The other issue is the control arm. These are patients that had measurable disease and visceral metastases, and typically we recommend chemotherapy to these patients and in other trials, chemotherapy has a median radiographic progression free survival of 8 to 9 months. So really the standard of care was not tested in the control arm. So at this point in time, along with the toxicity of the regimen, which was not easy, 40 to 60% of patients needed a dose hold or reduction or a delay in their therapy.
So really at this time, I would not be able to recommend this treatment as a standard of care.
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