ASCO 2022 | Final results from ATLANTIS cabozantinib arm for urothelial carcinoma
Robert J. Jones, MD, PhD, University of Glasgow & Beatson West of Scotland Cancer Centre, Glasgow, UK, discusses the final results from the cabozantinib arm of the ATLANTIS trial, which investigated cabozantinib vs. placebo in the maintenance setting for patients with advanced urothelial carcinoma. The ATLANTIS trial is a precision medicine maintenance platform trial, which enrolled patients into clinical trials based on biomarker testing of tissue collected during first-line chemotherapy. Dr Jones presented results on the cabozantinib arm, in which patients received cabozantinib or placebo as maintenance therapy until radiographic progression of disease. The trial did not report any new toxicities, but did not meet the primary endpoint of progression-free survival. This interview took place at the American Society of Clinical Oncology (ASCO) 2022 Annual Meeting in Chicago, IL.
Transcript (edited for clarity)
I’ve been presenting some results from the ATLANTIS platform trial. So this is a UK wide precision medicine platform trial in the maintenance setting. So this is patients who are enrolled during first line chemotherapy for advanced urothelial cancer. During the chemotherapy, the patients submit archival tissue for biomarker testing. Then at the end of chemotherapy, if they still just got ongoing clinical benefit, that is stable disease, partial response, complete response at the end of chemotherapy, they’re then offered randomization into one of a suite of different clinical trials depending on their biomarker status...
I’ve been presenting some results from the ATLANTIS platform trial. So this is a UK wide precision medicine platform trial in the maintenance setting. So this is patients who are enrolled during first line chemotherapy for advanced urothelial cancer. During the chemotherapy, the patients submit archival tissue for biomarker testing. Then at the end of chemotherapy, if they still just got ongoing clinical benefit, that is stable disease, partial response, complete response at the end of chemotherapy, they’re then offered randomization into one of a suite of different clinical trials depending on their biomarker status. So we presented the results of the rucaparib randomization at the GU meeting earlier in 2022. And that was a positive signal. Some patients were directed towards a randomization between enzalutamide or placebo. If they’re AR positive, we haven’t shown the results of that yet. This was actually the rest of them.
So these are patients who were negative for those biomarkers and they were randomized to receive either cabozantinib or placebo. So cabozantinib is an oral multi tyrosine kinase inhibitor, principally vascular endothelial growth factor receptor, but also some other targets which are probably relevant in urothelial cancer. And they continue with that until radiographic progression. So signal searching study, it’s a negative study. Primary endpoint is progression free survival, and there was really no difference between the two arms of the trial. Similarly for overall survival. Toxicity wise, and this is a drug which is widely used particularly in the treatment of renal cancer, nothing new to see, which was generally well tolerated, albeit with quite a significant number of dose reductions to get total ability. So obviously the trial is that niche is no longer appropriate because the standard of care has moved on in that setting. So the trial’s actually now closed, because it’s no longer really ethical to randomize patients against placebo in that setting.
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