Cabozantinib plus Nivolumab Phase I Expansion Study in Patients with Metastatic Urothelial Carcinoma Refractory to Immune Checkpoint Inhibitor Therapy

• Published in: Clinical cancer research 2022-04, Vol.28 (7), p.1353-1362
• Main Authors: Girardi, Daniel M, Niglio, Scot A, Mortazavi, Amir, Nadal, Rosa, Lara, Primo, Pal, Sumanta K, Saraiya, Biren, Cordes, Lisa, Ley, Lisa, Ortiz, Olena Sierra, Cadena, Jacqueline, Diaz, Carlos, Bagheri, Hadi, Redd, Bernadette, Steinberg, Seth M, Costello, Rene, Chan, Keith S, Lee, Min-Jung, Lee, Sunmin, Yu, Yunkai, Gurram, Sandeep, Chalfin, Heather J, Valera, Vladimir, Figg, William D, Merino, Maria, Toubaji, Antoun, Streicher, Howard, Wright, John J, Sharon, Elad, Parnes, Howard L, Ning, Yang-Min, Bottaro, Donald P, Cao, Liang, Trepel, Jane B, Apolo, Andrea B
• Format: Article
• Language: English
• Subjects: Anilides; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Carcinoma, Transitional Cell - drug therapy; Humans; Immune Checkpoint Inhibitors; Nivolumab; Pyridines; Urinary Bladder Neoplasms - drug therapy
• ISSN: 1078-0432; 1557-3265
• DOI: 10.1158/1078-0432.CCR-21-3726

This study investigated the efficacy and tolerability of cabozantinib plus nivolumab (CaboNivo) in patients with metastatic urothelial carcinoma (mUC) that progressed on checkpoint inhibition (CPI). A phase I expansion cohort of patients with mUC who received prior CPI was treated with cabozantinib 40 mg/day and nivolumab 3 mg/kg every 2 weeks until disease progression/unacceptable toxicity. The primary goal was objective response rate (ORR) per RECIST v.1.1. Secondary objectives included progression-free survival (PFS), duration of response (DoR), overall survival (OS), safety, and tolerability. Twenty-nine out of 30 patients enrolled were evaluable for efficacy. Median follow-up was 22.2 months. Most patients (86.7%) received prior chemotherapy and all patients received prior CPI (median seven cycles). ORR was 16.0%, with one complete response and three partial responses (PR). Among 4 responders, 2 were primary refractory, 1 had a PR, and 1 had stable disease on prior CPI. Median DoR was 33.5 months [95% confidence interval (CI), 3.7-33.5], median PFS was 3.6 months (95% CI, 2.1-5.5), and median OS was 10.4 months (95% CI, 5.8-19.5). CaboNivo decreased immunosuppressive subsets such as regulatory T cells (Tregs) and increased potential antitumor immune subsets such as nonclassical monocytes and effector T cells. A lower percentage of monocytic myeloid-derived suppressor cells (M-MDSC) and polymorphonuclear MDSCs, lower CTLA-4 and TIM-3 expression on Tregs, and higher effector CD4+ T cells at baseline were associated with better PFS and/or OS. CaboNivo was clinically active, well tolerated, and favorably modulated peripheral blood immune subsets in patients with mUC refractory to CPI.