As anticipated and subsequently confirmed, the CABINET study confirms that Vascular Endothelial Growth Factor (VEGF) inhibitors demonstrate efficacy not only in pancreatic Neuroendocrine Tumors (NETs) but also in extrapancreatic sites. Similar to lenvatinib, cabozantinib exhibited significant clinical benefits in this study, leading to the unblinding of patient data during interim analysis and their continued enrollment in the treatment regimen for the remainder of the study duration.
Undoubtedly, these findings pave the way for cabozantinib’s approval in the United States; however, European Medicines Agency (EMA) approval remains pending. Experts posit that the existing robust data substantiates the case for approving cabozantinib for tumours such as pancreatic, gastrointestinal (GI), and lung NETs.
Concerns may arise regarding the toxicity profile, given that approximately 60% of patients exhibited grade 3 adverse events. It is plausible that patients at advanced stages of treatment may be more vulnerable to the effects of novel drugs. The necessity for Quality of Life (QoL) scoring remains uncertain. This ambiguity arises from the heavily pretreated nature of the patient cohort, where prior therapies could potentially influence the adverse effects attributed to cabozantinib.
Indeed, several aspects require further establishment and exploration. Nevertheless, the noteworthy development lies in the emergence of a new contender in the therapeutic landscape. This development is crucial, given that a substantial proportion of our patient population has exhausted conventional treatment options. The study’s groundbreaking revelation lies in the introduction of a novel therapeutic option that demonstrates efficacy across a broad spectrum of NET tumours.
References:
Chan J. – Alliance A021602: Phase III, double-blinded study of cabozantinib versus placebo for advanced neuroendocrine tumors (NET) after progression on prior therapy (CABINET). ESMO2023 – #LBA53
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