Exelixis Announces Results from Subgroup Analysis of Phase 3 CABINET Pivotal Study Evaluating Cabozantinib in Advanced Gastrointestinal Neuroendocrine Tumors Presented at ASCO GI 2025
Exelixis (NASDAQ: EXEL) has announced positive results from a subgroup analysis of the phase 3 CABINET study evaluating cabozantinib in patients with gastrointestinal neuroendocrine tumors (GI NET). The analysis showed that cabozantinib reduced the risk of disease progression or death by 50% compared to placebo.
The study included 116 patients, with primary tumor locations predominantly in the ileum/cecum (54%) and small intestine (20%). Median progression-free survival was 8.5 months with cabozantinib versus 5.6 months with placebo. One patient achieved partial response with cabozantinib, while 48 patients achieved stable disease compared to 30 with placebo.
The FDA is currently reviewing Exelixis's supplemental New Drug Application for cabozantinib in advanced neuroendocrine tumors, with a target action date of April 3, 2025. Common grade 3/4 adverse events included hypertension (19%), diarrhea (13%), and fatigue (10%).
Exelixis (NASDAQ: EXEL) ha annunciato risultati positivi da un'analisi di sottogruppo dello studio di fase 3 CABINET che valuta il cabozantinib in pazienti con tumori neuroendocrini gastrointestinali (GI NET). L'analisi ha mostrato che il cabozantinib ha ridotto il rischio di progressione della malattia o morte del 50% rispetto al placebo.
Lo studio ha incluso 116 pazienti, con localizzazioni tumorali primarie prevalentemente nell'ileo/ceco (54%) e nell'intestino tenue (20%). La mediana della sopravvivenza libera da progressione è stata di 8,5 mesi con cabozantinib contro 5,6 mesi con placebo. Un paziente ha ottenuto una risposta parziale con cabozantinib, mentre 48 pazienti hanno raggiunto una malattia stabile rispetto ai 30 con placebo.
La FDA sta attualmente esaminando la richiesta di approvazione di un farmaco nuovo supplementare di Exelixis per il cabozantinib nei tumori neuroendocrini avanzati, con una data di azione prevista per il 3 aprile 2025. Gli eventi avversi comuni di grado 3/4 includevano ipertensione (19%), diarrea (13%) e affaticamento (10%).
Exelixis (NASDAQ: EXEL) ha anunciado resultados positivos de un análisis de subgrupo del estudio de fase 3 CABINET que evalúa cabozantinib en pacientes con tumores neuroendocrinos gastrointestinales (GI NET). El análisis mostró que cabozantinib redujo el riesgo de progresión de la enfermedad o muerte en un 50% en comparación con el placebo.
El estudio incluyó a 116 pacientes, con las localizaciones tumorales primarias predominantemente en el íleon/ceco (54%) y el intestino delgado (20%). La mediana de supervivencia libre de progresión fue de 8,5 meses con cabozantinib frente a 5,6 meses con placebo. Un paciente alcanzó una respuesta parcial con cabozantinib, mientras que 48 pacientes lograron enfermedad estable en comparación con 30 con placebo.
La FDA está revisando actualmente la solicitud de nuevo fármaco suplementario de Exelixis para cabozantinib en tumores neuroendocrinos avanzados, con una fecha de acción objetivo del 3 de abril de 2025. Los eventos adversos comunes de grado 3/4 incluyeron hipertensión (19%), diarrea (13%) y fatiga (10%).
Exelixis (NASDAQ: EXEL)는 위장신경내분비종양(GI NET) 환자에서 카보잔티닙을 평가하는 3상 CABINET 연구의 하위 그룹 분석에서 긍정적인 결과를 발표했습니다. 분석 결과, 카보잔티닙은 위약에 비해 질병 진행 또는 사망의 위험을 50% 감소시킨 것으로 나타났습니다.
이 연구에는 116명의 환자가 포함되었으며, 주된 종양 위치는 주로 회장/맹장(54%)과 소장(20%)에 있었습니다. 카보잔티닙으로 치료받은 환자의 중앙 무진행 생존 기간은 8.5개월였으며, 위약을 받으면 5.6개월이었습니다. 한 환자가 카보잔티닙으로 부분 반응을 얻었고, 48명의 환자가 안정적인 질병을 달성한 반면, 위약을 받은 환자는 30명이었습니다.
FDA는 현재 고급 신경내분비 종양에서 카보잔티닙에 대한 Exelixis의 보충 신약 신청서를 검토하고 있으며, 목표 행동 날짜는 2025년 4월 3일입니다. 일반적인 3/4등급 이상 부작용은 고혈압(19%), 설사(13%), 및 피로(10%)가 포함되었습니다.
Exelixis (NASDAQ: EXEL) a annoncé des résultats positifs d'une analyse de sous-groupe de l'étude de phase 3 CABINET évaluant le cabozantinib chez des patients atteints de tumeurs neuroendocrines gastro-intestinales (GI NET). L'analyse a montré que le cabozantinib a réduit le risque de progression de la maladie ou de décès de 50% par rapport au placebo.
L'étude a inclus 116 patients, avec des localisations tumorales primaires majoritairement dans l'iléon/caecum (54%) et l'intestin grêle (20%). La médiane de survie sans progression était de 8,5 mois avec cabozantinib contre 5,6 mois avec placebo. Un patient a obtenu une réponse partielle avec cabozantinib, tandis que 48 patients ont atteint une maladie stable par rapport à 30 avec placebo.
La FDA examine actuellement la demande de nouveau médicament supplémentaire d'Exelixis pour le cabozantinib dans les tumeurs neuroendocrines avancées, avec une date d'action cible du 3 avril 2025. Les événements indésirables courants de grade 3/4 comprenaient l'hypertension (19%), la diarrhée (13%) et la fatigue (10%).
Exelixis (NASDAQ: EXEL) hat positive Ergebnisse aus einer Subgruppenanalyse der Phase-3-Studie CABINET veröffentlicht, die Cabozantinib bei Patienten mit gastrointestinalen neuroendokrinen Tumoren (GI NET) evaluiert. Die Analyse ergab, dass Cabozantinib das Risiko eines Krankheitsverlaufs oder Todes um 50% im Vergleich zum Placebo reduzierte.
Die Studie umfasste 116 Patienten, wobei die primären Tumorlokalisierungen überwiegend im Ileum/Caecum (54%) und im Dünndarm (20%) lagen. Die mediane progressionsfreie Überlebenszeit betrug 8,5 Monate mit Cabozantinib im Vergleich zu 5,6 Monaten mit Placebo. Ein Patient erreichte eine partielle Reaktion mit Cabozantinib, während 48 Patienten eine stabile Erkrankung im Vergleich zu 30 mit Placebo erzielten.
Die FDA überprüft derzeit den ergänzenden Neuwagen-Antrag von Exelixis für Cabozantinib bei fortgeschrittenen neuroendokrinen Tumoren, mit einem angestrebten Entscheidungstermin am 3. April 2025. Häufige Nebenwirkungen der Grade 3/4 umfassten Bluthochdruck (19%), Durchfall (13%) und Müdigkeit (10%).
- 50% reduction in risk of disease progression or death compared to placebo
- Median PFS improvement of 2.9 months (8.5 vs 5.6 months)
- FDA review of sNDA with clear target action date of April 3, 2025
- Early trial termination due to substantial PFS improvement
- Three grade 5 (fatal) events possibly related to cabozantinib treatment
- Significant adverse events including hypertension (19%), diarrhea (13%), and fatigue (10%)
- response rate with only one partial response achieved
Insights
The subgroup analysis of the CABINET trial reveals compelling efficacy data for cabozantinib in GI neuroendocrine tumors, a difficult-to-treat cancer with therapeutic options. The 50% reduction in progression risk (HR: 0.50) and 2.9-month PFS improvement represent clinically meaningful benefits that could position cabozantinib as a new standard of care.
The safety profile aligns with cabozantinib's known characteristics, with manageable adverse events primarily including hypertension, diarrhea and fatigue. While the three treatment-related deaths warrant attention, they don't appear to significantly impact the overall risk-benefit profile given the advanced disease setting.
Several factors strengthen the regulatory case:
- Consistent benefit across multiple patient subgroups, including those who received prior Lu-177 dotatate or everolimus
- Strong statistical significance (p=0.007)
- Early trial stoppage due to efficacy
- Publication in the prestigious New England Journal of Medicine
With the FDA decision expected by April 3, 2025, approval could open a significant commercial opportunity. GI NET represents the majority of NET cases and the positive data in previously treated patients positions cabozantinib as a valuable later-line option. The broad activity across various GI NET subtypes (ileum/cecum 54%, small intestine 20%) suggests wide potential applicability.
While the objective response rate was modest (one partial response), the disease control rate was meaningful, with 48 patients achieving stable disease in the treatment arm versus 30 in placebo. This aligns with the treatment goals in NET, where disease stabilization is often considered a clinically relevant outcome.
– Cabozantinib reduced the risk of disease progression or death by 50 percent compared with placebo in patients with advanced gastrointestinal neuroendocrine tumors –
– Supplemental New Drug Application under review with the
“Treating neuroendocrine tumors after disease progression can be challenging, including for those with tumors in the gastrointestinal tract, as treatment options are limited,” said Jonathan Strosberg, M.D., President Emeritus, North American Neuroendocrine Tumor Society and Chair, GI Research Program, Moffitt Cancer Center and Research Institute. “This subgroup analysis from the CABINET study showed that cabozantinib improved progression-free survival for patients with tumors arising in the GI tract and provides a more detailed picture of how patients with the most common form of this cancer may benefit from this treatment. As a physician, I’m encouraged by these findings, as they suggest cabozantinib has potential to become a standard of care for patients greatly in need of new options.”
This subgroup analysis included 116 of the 203 patients in the epNET cohort. The most common primary tumor locations were ileum/cecum (
Cabozantinib was associated with improved PFS by blinded independent central review compared with placebo for patients with GI NET (hazard ratio: 0.50;
“These new data add to the robust results from the CABINET trial that demonstrate the benefits of cabozantinib across a wide range of patients with neuroendocrine tumors and further underscore the potential of cabozantinib to become a much-needed new option for those with GI NET, which accounts for the majority of real-world patients with this tumor type,” said Amy Peterson, M.D., Executive Vice President, Product Development & Medical Affairs, and Chief Medical Officer, Exelixis. “We look forward to continuing to work with the
The safety profile of cabozantinib observed in patients with GI NET was consistent with its known safety profile; no new safety signals were identified. The most frequent grade 3/4 adverse events included hypertension (
As announced in August 2023, the Alliance for Clinical Trials in Oncology independent Data and Safety Monitoring Board unanimously recommended that the CABINET trial be stopped early and unblinded due to the substantial improvement in PFS observed at an interim analysis. Final PFS results were presented at the 2024 European Society of Medical Oncology Congress and published concurrently in the New England Journal of Medicine. In August 2024, Exelixis announced that the
About CABINET (Alliance A021602)
CABINET (Randomized, Double-Blinded Phase III Study of CABozantinib versus Placebo In Patients with Advanced NEuroendocrine Tumors After Progression on Prior Therapy) is sponsored by the National Cancer Institute (NCI), part of the National Institutes of Health, and is being led and conducted by the NCI-funded Alliance for Clinical Trials in Oncology with participation from the NCI-funded National Clinical Trials Network as part of Exelixis’ collaboration through a Cooperative Research and Development Agreement with the NCI’s Cancer Therapy Evaluation Program.
CABINET is a multicenter, randomized, double-blinded, placebo-controlled phase 3 pivotal trial that had enrolled a total of 298 patients in the
About NET
NET are cancers that begin in the specialized cells of the body’s neuroendocrine system.1 These cells have traits of both hormone-producing endocrine cells and nerve cells.1 In 2024, the estimated prevalence of NET in the
NET can develop in any part of the body, but most commonly start in the GI tract or in the lungs, where they have historically been referred to as carcinoid tumors and are more recently called epNET.1 The five-year survival rates for advanced GI and lung NET tumors are
About CABOMETYX® (cabozantinib)
In the
CABOMETYX is not indicated as a treatment for NET.
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 http://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 CABINET trial at ASCO GI 2025; the therapeutic potential of cabozantinib as a treatment across a wide range of patients with neuroendocrine tumors and the potential of cabozantinib to become a much-needed new option for those with GI NET; the regulatory review process with respect to Exelixis’ sNDA for cabozantinib in previously treated advanced NET, including the Prescription Drug User Fee Act target action date assigned by the FDA; and Exelixis’ scientific pursuit to create transformational treatments that give more patients hope for the future. Any statements that refer to expectations, projections or other characterizations of future events or circumstances are forward-looking statements and are based upon Exelixis’ current plans, assumptions, beliefs, expectations, estimates and projections. Forward-looking statements involve risks and uncertainties. Actual results and the timing of events could differ materially from those anticipated in the forward-looking statements as a result of these risks and uncertainties, which include, without limitation: the availability of data at the referenced times; complexities and the unpredictability of the regulatory review and approval processes in the
Exelixis, the Exelixis logo and CABOMETYX are registered
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1 Neuroendocrine Tumors. Cleveland Clinic website. Available at: https://my.clevelandclinic.org/health/diseases/22006-neuroendocrine-tumors-net. Accessed January 2025. |
2 Population Estimate: Unresectable, Locally Advanced or Metastatic Extra-Pancreatic NET. June 2024 (internal data on file). |
3 Pathak, S., Starr, J.S., Halfdanarson T., et al. Understanding the increasing incidence of neuroendocrine tumors. Expert Rev Endocrinol Metab. September 2023;18(5):377-385. |
4 Pancreatic Neuroendocrine Tumors (Islet Cell Tumors) Treatment (PDQ®)–Patient Version. NCI website. Available at: https://www.cancer.gov/types/pancreatic/patient/pnet-treatment-pdq. Accessed January 2025. |
5 What Is a Pancreatic Neuroendocrine Tumor? ACS website. Available at: https://www.cancer.org/cancer/types/pancreatic-neuroendocrine-tumor/about/what-is-pnet.html. Accessed January 2025. |
6 McClellan, K., Chen. E.Y, Kardosh A., et al. Therapy Resistant Gastroenteropancreatic Neuroendocrine Tumors. Cancers. 2022, 14(19), 4769. |
7 What is a Gastrointestinal Carcinoid Tumor? ACS website. Available at: https://www.cancer.org/cancer/types/gastrointestinal-carcinoid-tumor/about/what-is-gastrointestinal-carcinoid.html. Accessed January 2025. |
8 Survival Rates for Gastrointestinal Carcinoid Tumors. ACS website. Available at: https://www.cancer.org/cancer/types/gastrointestinal-carcinoid-tumor/detection-diagnosis-staging/survival-rates.html. Accessed January 2025. |
9 Survival Rates for Lung Carcinoid Tumors. ACS website. Available at: https://www.cancer.org/cancer/types/lung-carcinoid-tumor/detection-diagnosis-staging/survival-rates.html. Accessed January 2025. |
10 Survival Rates for Pancreatic Neuroendocrine Tumor. ACS website. Available at: https://www.cancer.org/cancer/types/pancreatic-neuroendocrine-tumor/detection-diagnosis-staging/survival-rates.html. Accessed January 2025. |
11 Neuroendocrine Tumor (NET). NCI website. Available at: https://www.cancer.gov/pediatric-adult-rare-tumor/rare-tumors/rare-endocrine-tumor/carcinoid-tumor. Accessed January 2025. |
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Investors:
Susan Hubbard
EVP, Public Affairs and
Investor Relations
Exelixis, Inc.
(650) 837-8194
shubbard@exelixis.com
Media:
Claire McConnaughey
Senior Director, Public Affairs
Exelixis, Inc.
(650) 837-7052
cmcconn@exelixis.com
Source: Exelixis, Inc.
FAQ
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