Physician Views: Can Exelixis' Cabometyx move into the first-line renal cell carcinoma market – FirstWord is polling oncologists to find out

Exelixis' Cabometyx was launched in the US market as a second-line treatment for renal cell carcinoma (RCC) in April and appears to have enjoyed a strong ramp-up in sales (Physician Views Poll Results: Efficacy profile driving usage of Cabometyx in renal cell carcinoma, say oncologists) – the company will report its third quarter earnings on Thursday (November 3).

Earlier this month at the ESMO congress, the company presented positive data from a 157-patient Phase II study, which compared Cabometyx to Pfizer's Sutent in first-line RCC. Exelixis exited the congress under some controversy, with one key opinion leader at ESMO suggesting that Phase III data should be required to support approval. Nevertheless, a number of experts spoke out in favour of Cabometyx as a first-line therapy and Exelixis will shortly begin the process to seek supplementary FDA approval of the drug in this indication.

Our latest Physician Views poll seeks to ascertain how practicing oncologists (in the US and EU5) evaluate data from the Phase II CABOSUN study and what impact approval would have on clinical practice. Specifically we are asking them…

Data from the 157-patient CABOSUN randomised Phase II trial of cabozantinib in patients with previously untreated advanced RCC with intermediate- or poor-risk disease per the IMDC, was recently presented at ESMO. With a median follow-up of 20.8 months, cabozantinib demonstrated a 31% reduction in the rate of disease progression or death [HR 0.69, 95% CI (0.48-0.99), one-sided P=0.012].

The median progression-free survival for cabozantinib was 8.2 months versus 5.6 months for sunitinib. Objective response rate was also significantly improved, at 46% (95% CI 34% – 57%) for cabozantinib versus 18% (95% CI 10% to 28%) for sunitinib. With a median follow up of 22.8 months, median overall survival was 30.3 months for cabozantinib versus 21.8 months for sunitinib [HR 0.80, 95% CI (0.50 - 1.26)]. Discontinuation rate due to an adverse event was 20% with cabozantinib and 21% with sunitinib.

How meaningful do you consider these data?

Not meaningful

Marginally meaningful

Moderately meaningful

Very meaningful

Extremely meaningful

Would you be confident prescribing cabozantinib in the patient setting described above if it was approved on the strength of these data only? (i.e. one Phase II study)

No

Marginally confident

Moderately confident

Very confident

Extremely confident

If cabozantinib was approved for the treatment of first-line RCC (on the strength of data outlined above) what impact would this likely have on your use of sunitinib as a first-line therapy in RCC?

No impact

Marginal reduction in use

Moderate reduction in use

Significant reduction in use

Very significant reduction in use

If cabozantinib was approved for the treatment of first-line RCC (on the strength of data outlined above) what impact would this likely have on your use of pazopanib as a first-line therapy?

No impact

Marginal reduction in use

Moderate reduction in use

Significant reduction in use

Very significant reduction in use

Would you consider prescribing cabozantinib to previously untreated RCC patients on an off-label basis prior to approval?

Never

Rarely

Sometimes

Often

Always

Results and related analysis will be published for FirstWord Pharma PLUS subscribers to read, with the opportunity for non-FirstWord Pharma PLUS subscribers to purchase these findings. To be notified when poll results and analysis become available, please click here.

As always, FirstWord would very much like to receive your feedback and suggestions. Note: FirstWord Polls are powered by MedePolls, a fast-turnaround service to conduct instant polls of up to five questions with guaranteed samples that include physicians from dozens of specialties and over 100 markets. To conduct this poll with a different audience, or an entirely different poll, contact us at info@firstwordpharma.com

To read more Physician Views articles, click here.