1. An Illustrative Case of Combination Cabozantinib/Nivolumab for Progressive Metastatic Renal Cell Carcinoma (mRCC)
- Author
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Chester Kao, Daniel J. George, and Tian Zhang
- Subjects
Oncology ,Vascular Endothelial Growth Factor A ,Cancer Research ,medicine.medical_specialty ,Cabozantinib ,Pyridines ,Immune checkpoint inhibitors ,VEGF receptors ,Pazopanib ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Renal cell carcinoma ,Internal medicine ,Medicine ,Humans ,Anilides ,030212 general & internal medicine ,Carcinoma, Renal Cell ,biology ,business.industry ,Sunitinib ,medicine.disease ,Disease control ,Kidney Neoplasms ,Nivolumab ,chemistry ,030220 oncology & carcinogenesis ,biology.protein ,business ,Brief Communications ,medicine.drug - Abstract
We report a case using combination cabozantinib/nivolumab to salvage disease control in a patient with refractory metastatic renal cell carcinoma (mRCC). The patient had previously experienced disease progression from high dose IL-2, sunitinib, pazopanib, cabozantinib, and nivolumab, all given sequentially. Combination cabozantinib/nivolumab resulted in 22 months of disease control. Vascular endothelial growth factor (VEGF) inhibitors including cabozantinib have immunomodulatory effects when combined with immune checkpoint inhibitors, with multiple ongoing phase 3 trials exploring the cabozantinib/nivolumab combination in the first line setting. To our knowledge, this is the first reported case of progression on nivolumab and cabozantinib when given as sequential monotherapies but stable disease on combination cabozantinib/nivolumab. IMPLICATIONS FOR PRACTICE: There is ongoing evaluation of combination VEGF-targeted therapies and immune checkpoint inhibitors given their potential mechanistic synergy. With the recent CHECKMATE 9ER press release reporting clinically meaningful benefit from the combination cabozantinib/nivolumab compared to sunitinib in the first line setting, this case of sustained stable disease with combination cabozantinib/nivolumab after progression on prior VEGF-targeting therapies and immunotherapies highlights the activity of this combination as a potential treatment alternative to improve disease control.
- Published
- 2020