Exelixis Announces Detailed Results of Phase 3 CONTACT-02 Pivotal Trial Evaluating Cabozantinib in Combination with Atezolizumab in Metastatic Castration-Resistant Prostate Cancer Presented at ASCO GU 2024
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Insights
The clinical trial results indicating a 35% reduction in disease progression or death for patients with metastatic castration-resistant prostate cancer (mCRPC) treated with cabozantinib in combination with atezolizumab present a significant advancement in oncology. From a medical perspective, the combination therapy's ability to improve progression-free survival (PFS) is a vital outcome, as mCRPC is known for its aggressive nature and limited treatment options after first-line hormonal therapies fail.
Furthermore, the sub-group analysis showing benefits across high-risk populations, including those with liver and bone metastases, suggests that the treatment could address unmet needs within this patient cohort. However, while the trend towards improved overall survival (OS) is promising, the lack of statistical significance at this stage warrants cautious optimism until further data are available.
Lastly, the reported adverse events (AEs) profile is critical for evaluating the treatment's tolerability. The higher incidence of treatment-emergent AEs in the combination therapy arm compared to the second novel hormonal therapy (NHT) arm suggests a need for careful patient monitoring and management strategies to mitigate these risks.
The CONTACT-02 trial's results have potential implications for Exelixis, Inc.'s business trajectory and stock performance. The statistically significant improvement in PFS, as assessed by a blinded independent radiology committee (BIRC) using RECIST 1.1 criteria, is a robust endpoint that regulatory agencies like the FDA often consider for drug approval. The median PFS improvement from 4.2 months to 6.3 months represents a clinically meaningful benefit that could position cabozantinib plus atezolizumab as a competitive therapy in the mCRPC market.
Investors should note that the progression to further discussions with the FDA based on these results could lead to an expanded indication for the drug combination, potentially increasing market share and revenue for Exelixis. However, the lack of mature OS data and the fact that it did not reach statistical significance at this interim analysis may impact the regulatory decision-making process and market confidence.
From a market perspective, the positive trial results for cabozantinib in combination with atezolizumab could influence Exelixis, Inc.'s positioning in the prostate cancer treatment landscape. The mCRPC treatment market is competitive, with several pharmaceutical companies vying for market share. The CONTACT-02 trial outcomes could enable Exelixis to capture a larger segment of this market, especially considering the limited treatment options available post-hormonal therapy.
It is essential to monitor the competitive dynamics, as Exelixis's success in securing FDA approval and market adoption will hinge on the comparative efficacy and safety profile of this combination therapy relative to existing treatments. Additionally, payers' willingness to reimburse for the therapy and its accessibility to patients will be critical factors determining its commercial success.
– Cabozantinib in combination with atezolizumab reduced the risk of disease progression or death by
– Findings to be presented during an oral presentation at ASCO GU 2024 –
“Patients with metastatic castration-resistant prostate cancer with prior progression on a novel hormone therapy and who have measurable soft tissue metastasis experience the worst outcomes among advanced prostate cancer patients and have limited treatment options,” said Neeraj Agarwal, M.D., FASCO, Senior Director for Clinical Research at Huntsman Cancer Institute at the University of
As announced in August 2023, CONTACT-02 met one of its primary endpoints, demonstrating a statistically significant improvement in progression-free survival (PFS) as assessed by a blinded independent radiology committee (BIRC) and per RECIST 1.1. The PFS analysis was conducted in the first 400 randomized patients in the intent-to-treat (PFS ITT) population and per protocol. Similar results were observed for all patients.
Detailed results presented at ASCO GU show that at a median follow-up of 14.3 months for the PFS ITT population, the hazard ratio (HR) was 0.65 (
The PFS benefit and the trend for an OS benefit were observed across subgroups of high-risk populations, as presented in Table 1.
TABLE 1 |
Liver metastasis |
Prior docetaxel for mCSPC |
Bone metastasis |
|||
Cabozantinib +
|
Second NHT |
Cabozantinib +
|
Second NHT |
Cabozantinib +
|
Second NHT |
|
Median PFS
|
6.2
|
2.1
|
8.8
|
4.1
|
6.3
|
4.1
|
Patients, n |
51 |
48 |
45 |
44 |
162 |
155 |
PFS HR
|
0.43
|
0.57
|
0.67
|
|||
Median OS,
|
16.4
|
9.8
|
20.9
|
11.3
|
16.4
|
11.4
|
Patients, n |
59 |
60 |
57 |
58 |
206 |
196 |
OS HR
|
0.60
|
0.56
|
0.74
|
|||
BIRC = blinded independent radiology committee; CI = confidence interval; HR = hazard ratio; mCSPC = metastatic castration-sensitive prostate cancer; NE = not evaluable; NHT = novel hormone therapy; OS = overall survival; PFS = progression-free survival |
Treatment-emergent adverse events (AEs) occurred in
“Given there are limited options after progression on novel hormonal therapy, we recognize the need for a regimen that can delay disease progression, that has an acceptable tolerability profile and that is widely available to patients who may not have the means or desire to travel to specialized centers for other therapies,” said Amy Peterson, M.D., Executive Vice President, Product Development & Medical Affairs, and Chief Medical Officer, Exelixis. “Our decision to conduct CONTACT-02, based upon a signal we observed in COMET-01, underscores our commitment to patients with advanced prostate cancer and to improving their standard of care. We look forward to discussing these important results with the
About CONTACT-02
CONTACT-02 is a global, multicenter, randomized, phase 3, open-label study that randomized 507 patients 1:1 to the experimental arm of cabozantinib in combination with atezolizumab and the control arm of a second NHT (either abiraterone and prednisone or enzalutamide). The two primary endpoints of the trial are PFS and OS. The study included patients with mCRPC who have measurable extra-pelvic soft tissue metastasis and who have progressed on one prior NHT. The secondary endpoint is objective response rate per BIRC. The trial is sponsored by Exelixis and co-funded by Ipsen, Roche and Takeda Pharmaceutical Company Limited (Takeda). Takeda is conducting the trial in
About CRPC
According to the American Cancer Society, approximately 299,000 new cases of prostate cancer will be diagnosed in the
About CABOMETYX® (cabozantinib)
In the
CABOMETYX in combination with atezolizumab is not indicated as a treatment for mCRPC.
IMPORTANT SAFETY INFORMATION
WARNINGS AND PRECAUTIONS
Hemorrhage: Severe and fatal hemorrhages occurred with CABOMETYX. The incidence of Grade 3 to 5 hemorrhagic events was
Perforations and Fistulas: Fistulas, including fatal cases, occurred in
Thrombotic Events: CABOMETYX increased the risk of thrombotic events. Venous thromboembolism occurred in
Hypertension and Hypertensive Crisis: CABOMETYX can cause hypertension, including hypertensive crisis. Hypertension was reported in
Diarrhea: Diarrhea occurred in
Palmar-Plantar Erythrodysesthesia (PPE): PPE occurred in
Hepatotoxicity: CABOMETYX in combination with nivolumab can cause hepatic toxicity with higher frequencies of Grades 3 and 4 ALT and AST elevations compared to CABOMETYX alone.
Monitor liver enzymes before initiation of and periodically throughout treatment. Consider more frequent monitoring of liver enzymes than when the drugs are administered as single agents. For elevated liver enzymes, interrupt CABOMETYX and nivolumab and consider administering corticosteroids.
With the combination of CABOMETYX and nivolumab, Grades 3 and 4 increased ALT or AST were seen in
Adrenal Insufficiency: CABOMETYX in combination with nivolumab can cause primary or secondary adrenal insufficiency. For Grade 2 or higher adrenal insufficiency, initiate symptomatic treatment, including hormone replacement as clinically indicated. Withhold CABOMETYX and/or nivolumab and resume CABOMETYX at a reduced dose depending on severity.
Adrenal insufficiency occurred in
Approximately
Proteinuria: Proteinuria was observed in
Osteonecrosis of the Jaw (ONJ): ONJ occurred in <
Impaired Wound Healing: Wound complications occurred with CABOMETYX. Withhold CABOMETYX for at least 3 weeks prior to elective surgery. Do not administer CABOMETYX for at least 2 weeks after major surgery and until adequate wound healing. The safety of resumption of CABOMETYX after resolution of wound healing complications has not been established.
Reversible Posterior Leukoencephalopathy Syndrome (RPLS): RPLS, a syndrome of subcortical vasogenic edema diagnosed by characteristic findings on MRI, can occur with CABOMETYX. Evaluate for RPLS in patients presenting with seizures, headache, visual disturbances, confusion, or altered mental function. Discontinue CABOMETYX in patients who develop RPLS.
Thyroid Dysfunction: Thyroid dysfunction, primarily hypothyroidism, has been observed with CABOMETYX. Based on the safety population, thyroid dysfunction occurred in
Patients should be assessed for signs of thyroid dysfunction prior to the initiation of CABOMETYX and monitored for signs and symptoms of thyroid dysfunction during CABOMETYX treatment. Thyroid function testing and management of dysfunction should be performed as clinically indicated.
Hypocalcemia: CABOMETYX can cause hypocalcemia. Based on the safety population, hypocalcemia occurred in
In COSMIC-311, hypocalcemia occurred in
Monitor blood calcium levels and replace calcium as necessary during treatment. Withhold and resume at reduced dose upon recovery or permanently discontinue CABOMETYX depending on severity.
Embryo-Fetal Toxicity: CABOMETYX can cause fetal harm. Advise pregnant women and females of reproductive potential of the potential risk to a fetus. Verify the pregnancy status of females of reproductive potential prior to initiating CABOMETYX and advise them to use effective contraception during treatment and for 4 months after the last dose.
ADVERSE REACTIONS
The most common (≥
CABOMETYX as a single agent: diarrhea, fatigue, PPE, decreased appetite, hypertension, nausea, vomiting, weight decreased, and constipation.
CABOMETYX in combination with nivolumab: diarrhea, fatigue, hepatotoxicity, PPE, stomatitis, rash, hypertension, hypothyroidism, musculoskeletal pain, decreased appetite, nausea, dysgeusia, abdominal pain, cough, and upper respiratory tract infection.
DRUG INTERACTIONS
Strong CYP3A4 Inhibitors: If coadministration with strong CYP3A4 inhibitors cannot be avoided, reduce the CABOMETYX dosage. Avoid grapefruit or grapefruit juice.
Strong CYP3A4 Inducers: If coadministration with strong CYP3A4 inducers cannot be avoided, increase the CABOMETYX dosage. Avoid St. John’s wort.
USE IN SPECIFIC POPULATIONS
Lactation: Advise women not to breastfeed during CABOMETYX treatment and for 4 months after the final dose.
Hepatic Impairment: In patients with moderate hepatic impairment, reduce the CABOMETYX dosage. Avoid CABOMETYX in patients with severe hepatic impairment.
Please see accompanying full Prescribing Information
https://www.cabometyx.com/downloads/CABOMETYXUSPI.pdf.
You are encouraged to report negative side effects of prescription drugs to the FDA.
Visit www.FDA.gov/medwatch or call 1-800-FDA-1088.
About Exelixis
Exelixis is a globally ambitious oncology company innovating next-generation medicines and regimens at the forefront of cancer care. Powered by drug discovery and development excellence, we are rapidly evolving our product portfolio to target an expanding range of tumor types and indications with our clinically differentiated pipeline of small molecules, antibody-drug conjugates and other biotherapeutics. This comprehensive approach harnesses decades of robust investment in our science and partnerships to advance our investigational programs and extend the impact of our flagship commercial product, CABOMETYX® (cabozantinib). Exelixis is driven by a bold scientific pursuit to create transformational treatments that give more patients hope for the future. For information about the company and its mission to help cancer patients recover stronger and live longer, visit www.exelixis.com, follow @ExelixisInc on X (Twitter), like Exelixis, Inc. on Facebook and follow Exelixis on LinkedIn.
Forward-Looking Statements
This press release contains forward-looking statements, including, without limitation, statements related to: the presentation of detailed results from the CONTACT-02 trial at ASCO GU 2024; the therapeutic potential of cabozantinib in combination with atezolizumab as an additional and readily available treatment option for patients with mCRPC and measurable extra-pelvic soft tissue disease who have progressed on one prior NHT; Exelixis’ commitment to patients with advanced prostate cancer and to improving their standard of care; Exelixis’ plans to discuss the CONTACT-02 results with the
Exelixis, the Exelixis logo and CABOMETYX are registered
1 Cancer Facts & Figures 2024. ACS website. Available at: https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2024/2024-cancer-facts-and-figures-acs.pdf. Accessed January 2024.
2 Prostate Cancer: Types of Treatment. Cancer.Net. Available at: https://www.cancer.net/cancer-types/prostate-cancer/types-treatment. Accessed January 2024.
3 Moreira, D. M., et al. Predicting Time From Metastasis to Overall Survival in Castration-Resistant Prostate Cancer: Results From SEARCH. Clin Genitourin Cancer. 2017; 15: 60–66.e2.
4 Freedland, S. J., et al. Real-world treatment patterns and overall survival among men with Metastatic Castration-Resistant Prostate Cancer (mCRPC) in the US Medicare population. Prostate Cancer Prostatic Dis. 2023.
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Investors Contact:
Susan Hubbard
EVP, Public Affairs and
Investor Relations
(650) 837-8194
shubbard@exelixis.com
Media Contact:
Claire McConnaughey
Senior Director,
Public Affairs
(650) 837-7052
cmcconn@exelixis.com
Source: Exelixis, Inc.
FAQ
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