At the 2024 ASCO Genitourinary Cancers Symposium, Enrique Grande, MD, PhD, MD Anderson Cancer Center Madrid, Spain, shared results from the multi-cohort, basket phase 2 CABATEN study, which evaluated the activity and safety of cabozantinib plus atezolizumab among patients with locally advanced or metastatic adrenocortical carcinoma.

Results demonstrated this combination showed modest activity in this patient population with a consistent safety profile.

Transcript: 

Hello, my name is Enrique Grande, I'm a medical oncologist based in Madrid at the MD Anderson Cancer Center. I'm focused on genitourinary tumors and also endocrine tumors in my daily practice. We are here in San Francisco at ASCO GU 2024 and I had the opportunity to present on behalf of the rest of the Spanish investigators this independent research study, the CABATEN trial that we perform at the Spanish Task Force Group for Neuroendocrine Tumors, which is called GETNE. 

In the CABATEN trial, we assessed the activity of the combination of cabozantinib, tyrosine kinase inhibitors, plus atezolizumab, a PD-L1 inhibitor, in a disease, adrenocortical carcinoma, which is a really unmet need that we have in daily practice. Adrenocortical carcinoma are very infrequent tumors affecting only 1 in 1 million people every year so this is a very, very uncommon disease and unfortunately we don't have any drugs approved since the seventies; mitotane, an antineoplastic agent, was approved in the seventies and nothing else has been approved since then. The 5-year overall survival is less than 15%, so we need more drugs, we need more things here.

Tyrosine kinase inhibitors, single-agent drugs, immune checkpoint inhibitors as a single-agent did not really show dramatic activity, so in this CABATEN trial we were looking for the activity of the combination of cabozantinib and atezolizumab in this scenario. Twenty four patients were recruited  and to consider the trial positive in terms of activity, we needed at least 3 of them responding, but unfortunately, only 2 patients achieved a radiological RECIST response. So in terms of activity, we can say that unfortunately we didn't meet the bar for activity. Progression-free survival was only 2.9 months, overall survival was 13 months, so unfortunately we cannot really claim for the activity of the combination. The safety profile was good, consistent with the combination of cabozantinib and atezolizumab that we saw in other solid tumors. These 2 patients that responded, they were really long lasting respondents. We are working on the translational biomarker part of the analysis and hopefully we will try to find any biomarker that may predict the activity for this combination, but unfortunately, overall for all comers, this combination is not really working. 

The conclusion for the CABATEN trial, well adrenocortical carcinoma with metastases is a real unmet need that we have. Only mitotane with or without cisplatin based chemotherapy is the standard of care, but there are no long lasting respondents in this setting. Cabozantinib and atezolizumab unfortunately didn't meet the pre-specified bar for activity, only 2 of the 24 patients recruited achieved a RECIST response. Safety profile was okay and consistent with the data that we have so far in this setting, and it merits diving deep into biomarkers trying to identify which is the patient profile, the molecular profile of these patients, localized responders. But unfortunately, the combination of  cabozantinib and atezolizumab is not working for all comers with adrenocortical carcinoma.

Source:

Grande E, Viñuales MB, Molina-Cerrillo J, et al. Cabozantinib plus atezolizumab in locally advanced/metastatic adrenocortical carcinoma: Results from a multi-cohort basket phase II trial, CABATEN/GETNE-T1914. Presented at the 2024 ASCO Genitourinary Cancers Symposium; January 25-27, 2024; San Francisco, California. Abstract 1