Cabozantinib, a new first-line treatment for advanced renal cell carcinoma (aRCC), targets essential tyrosine kinases and outperforms the established comparator (sunitinib) in various efficacy outcomes. This systematic review and meta-analysis aimed to assess the efficacy and safety of cabozantinib compared to other aRCC treatments.
Following PRISMA and Cochrane guidelines, our protocol was registered in PROSPERO. A systematic search, without date limits, was conducted on PubMed, Cochrane, Web of Science, and EMBASE until October 8, 2023. Data extraction encompassed study details, baseline information, and outcomes. Hazard ratios (HR) and risk ratios (RR) with 95% confidence intervals were employed for each outcome, and a random-effects model was applied to account for expected heterogeneity.
Three studies, encompassing 967 patients, were included in our analysis. In terms of efficacy, the pooled rate for overall survival significantly favored cabozantinib. However, in subgroup analyses, cabozantinib was only statistically superior to everolimus. For progression-free survival and tumor objective response rate, cabozantinib outperformed both everolimus and sunitinib. In adverse events, compared to sunitinib, cabozantinib exhibited inferiority in nearly all evaluated aspects, except for nausea and stomatitis, which showed no difference between the two groups. Conversely, it demonstrated a comparable risk profile with everolimus across various side effects.
Cabozantinib shows significant efficacy in extending overall survival, progression-free survival, and tumor objective response rate despite a potentially higher risk of adverse events compared to sunitinib. These findings support cabozantinib as a first-line therapy for aRCC, either as an initial treatment or after prior VEGFR-targeted therapies.
Proceedings (Baylor University. Medical Center). 2024 Jun 17*** epublish ***
Majd M AlBarakat, Yaman B Ahmed, Sakhr Alshwayyat, Asmaa Ellaithy, Yaqoub Y Al-Shammari, Youssef Soliman, Hazem Rezq, Basel Abdelazeem, Arvind Kunadi
Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan., Faculty of Medicine, Suez Canal University, Ismailia, Egypt., Faculty of Medicine, Assiut University, Assiut, Egypt., Faculty of Medicine, Al-Azhar University, Cairo, Egypt., Department of Cardiology, West Virginia University, Morgantown, West Virginia, USA., Internal Medicine and Nephrology Departments, McLaren Health Care, Flint, Michigan, USA.