PMID- 36328934 OWN - NLM STAT- MEDLINE DCOM- 20230418 LR - 20230421 IS - 2588-9311 (Electronic) IS - 2588-9311 (Linking) VI - 6 IP - 2 DP - 2023 Apr TI - Real-world Practice Patterns and Safety of Concurrent Radiotherapy and Cabozantinib in Metastatic Renal Cell Carcinoma: Results from the International Metastatic Renal Cell Carcinoma Database Consortium. PG - 204-211 LID - S2588-9311(22)00174-2 [pii] LID - 10.1016/j.euo.2022.10.004 [doi] AB - BACKGROUND: There is a paucity of data on the safety of cabozantinib use in combination with radiotherapy. OBJECTIVE: To report the practice patterns, safety, and efficacy of cabozantinib with radiotherapy in metastatic renal cell carcinoma (mRCC). DESIGN, SETTING, AND PARTICIPANTS: An international multicenter retrospective study was conducted. Patients with mRCC treated with cabozantinib at any line of therapy and who received radiotherapy between 30 d prior to the start date of cabozantinib and 30 d following discontinuation of cabozantinib, from 2014 to 2020, were included. Concurrent use was defined as the use of cabozantinib on radiotherapy treatment days during any course of radiotherapy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary outcomes of interest were the rate of grade >/=3 adverse events (AEs) occurring within 90 d of receipt of radiotherapy. Secondary outcomes included hospitalization rate and patterns of cabozantinib and radiotherapy use. Baseline characteristics and AEs were presented descriptively. RESULTS AND LIMITATIONS: A total of 127 consecutive patients were included. Most patients had clear cell histology (88%), had International Metastatic Renal Cell Carcinoma Database Consortium intermediate-risk disease (57%), and had received at least one prior line of therapy (93%). Of 127 patients, 67 (53%) received concurrent cabozantinib with radiotherapy, while the remaining held cabozantinib on radiotherapy days. Overall, grade 3-4 AEs occurred in 6.3% (n = 8/127) of patients. No grade 5 events were observed. In patients treated with conventional palliative radiotherapy (n = 88), the rate of grade 3-4 AEs in those who had concurrent versus those who had nonconcurrent cabozantinib was 6.3% (n = 3/48) versus 5.0% (n = 2/40). No patient was hospitalized due to radiotherapy-related toxicity. In patients treated with stereotactic ablative body radiotherapy (SABR; n = 50), the rate of grade 3-4 AEs in those who had concurrent versus those who had nonconcurrent cabozantinib was 3.6% (n = 1/28) versus 9.1% (n = 2/22). One patient in the nonconcurrent group was hospitalized due to muscle weakness suspected to be related to associated vasogenic edema 19 d after SABR for multiple brain metastases. CONCLUSIONS: In this real-world study of patients with mRCC treated with cabozantinib, 53% of patients received radiotherapy concurrently, with few grade 3-4 AEs reported within 90 d of receiving radiotherapy. The use of radiotherapy and cabozantinib requires a risk-benefit assessment of patient and disease characteristics to optimize therapy regimens. PATIENT SUMMARY: Our study reports the real-world experience of using radiotherapy in patients receiving cabozantinib for metastatic kidney cancer. Over half of the patients continued taking cabozantinib while receiving radiotherapy, and few patients developed serious side effects. The combined use of radiotherapy and cabozantinib requires a careful risk-benefit assessment to achieve optimal treatment outcomes. CI - Copyright (c) 2022 European Association of Urology. Published by Elsevier B.V. All rights reserved. FAU - Loo Gan, Chun AU - Loo Gan C AD - Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada. FAU - Huang, Jiaming AU - Huang J AD - Dana-Farber Cancer Institute/Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA. FAU - Pan, Elizabeth AU - Pan E AD - University of California San Diego, La Jolla, CA, USA. FAU - Xie, Wanling AU - Xie W AD - Dana-Farber Cancer Institute/Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA. FAU - Schmidt, Andrew L AU - Schmidt AL AD - Dana-Farber Cancer Institute/Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA. FAU - Labaki, Chris AU - Labaki C AD - Dana-Farber Cancer Institute/Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA. FAU - Meza, Luis AU - Meza L AD - City of Hope Comprehensive Cancer Center, Duarte, CA, USA. FAU - Bouchard, Gabrielle AU - Bouchard G AD - Dana-Farber Cancer Institute/Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA. FAU - Li, Haoran AU - Li H AD - Division of Medical Oncology, Department of Internal Medicine, University of Utah Huntsman Cancer Institute, Salt Lake City, UT, USA. FAU - Jackson-Spence, Francesca AU - Jackson-Spence F AD - Barts Cancer Institute, Queen Mary University of London, London, UK. FAU - Sanchez-Ruiz, Carla AU - Sanchez-Ruiz C AD - Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain. FAU - Powles, Thomas AU - Powles T AD - Barts Cancer Institute, Queen Mary University of London, London, UK. FAU - Kumar, Shruti A AU - Kumar SA AD - Division of Medical Oncology, Department of Internal Medicine, University of Utah Huntsman Cancer Institute, Salt Lake City, UT, USA. FAU - Weise, Nicole AU - Weise N AD - University of California San Diego, La Jolla, CA, USA. FAU - Hall, William A AU - Hall WA AD - Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA. FAU - Rose, Brent S AU - Rose BS AD - Dana-Farber Cancer Institute/Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA. FAU - Beuselinck, Benoit AU - Beuselinck B AD - University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium. FAU - Suarez, Cristina AU - Suarez C AD - Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain. FAU - Pal, Sumanta K AU - Pal SK AD - City of Hope Comprehensive Cancer Center, Duarte, CA, USA. FAU - Choueiri, Toni K AU - Choueiri TK AD - Dana-Farber Cancer Institute/Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA. FAU - Heng, Daniel Y C AU - Heng DYC AD - Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada. FAU - McKay, Rana R AU - McKay RR AD - University of California San Diego, La Jolla, CA, USA. Electronic address: rmckay@health.ucsd.edu. LA - eng PT - Journal Article PT - Multicenter Study DEP - 20221101 PL - Netherlands TA - Eur Urol Oncol JT - European urology oncology JID - 101724904 RN - 1C39JW444G (cabozantinib) RN - 0 (Anilides) SB - IM CIN - Eur Urol Oncol. 2023 Apr;6(2):212-213. PMID: 36522250 MH - Humans MH - *Carcinoma, Renal Cell/drug therapy/radiotherapy MH - *Kidney Neoplasms/drug therapy/radiotherapy MH - Retrospective Studies MH - Anilides/adverse effects OTO - NOTNLM OT - Cabozantinib OT - Concomitant radiotherapy and cabozantinib OT - Concurrent radiotherapy and cabozantinib OT - International Metastatic Renal Cell Carcinoma Database Consortium OT - Palliative radiotherapy OT - Radiotherapy OT - Real-world evidence OT - Renal cell carcinoma OT - Stereotactic body radiotherapy EDAT- 2022/11/04 06:00 MHDA- 2023/04/18 06:42 CRDT- 2022/11/03 23:07 PHST- 2022/05/16 00:00 [received] PHST- 2022/08/26 00:00 [revised] PHST- 2022/10/10 00:00 [accepted] PHST- 2023/04/18 06:42 [medline] PHST- 2022/11/04 06:00 [pubmed] PHST- 2022/11/03 23:07 [entrez] AID - S2588-9311(22)00174-2 [pii] AID - 10.1016/j.euo.2022.10.004 [doi] PST - ppublish SO - Eur Urol Oncol. 2023 Apr;6(2):204-211. doi: 10.1016/j.euo.2022.10.004. Epub 2022 Nov 1.