A randomized phase II study of cabozantinib versus weekly paclitaxel in the treatment of persistent or recurrent epithelial ovarian, fallopian tube or primary peritoneal cancer: An NRG Oncology/Gynecologic Oncology Group study.

Abstract

INTRODUCTION\nCabozantinib is a receptor tyrosine kinases inhibitor that targets MET (c-MET), VEGF receptor 2 (VEGFR2), RET, AXL, KIT, FLT-3, and TIE-2 and previously showed promising single agent activity in recurrent ovarian cancer.\n\n\nMETHODS\nThis was an open label, 1:1 randomized study of cabozantinib 60\u202fmg orally (PO) daily versus weekly paclitaxel 80\u202fmg/m2 given 3 out of 4\u202fweeks (NCT01716715); 111 patients were enrolled. Eligibility included persistent or recurrent epithelial ovarian, fallopian tube, or primary peritoneal carcinoma and at least one but no >3 prior chemotherapy regimens.\n\n\nRESULTS\nMedian PFS was similar for both treatment groups and was 5.3\u202fmonths for cabozantinib and 5.5\u202fmonths for weekly paclitaxel (HR 1.11 (90% CI 0.77-1.61, p\u202f=\u202f0.64)). Secondary analyses of overall survival (OS) and event free survival (EFS) showed that cabozantinib did not perform as well as weekly paclitaxel. Median OS for cabozantinib was 19.4\u202fmonths and was not reached for weekly paclitaxel (HR 2.27 (90% CI 1.17-4.41, p\u202f=\u202f0.04). EFS was also worse in the cabozantinib arm, 3.5\u202fmonths, compared to weekly paclitaxel at 5.0\u202fmonths (HR 1.81 (90% CI 1.24-2.63, p\u202f=\u202f0.01). Overall response rate (ORR) was less for cabozantinib compared to weekly paclitaxel (7% versus 24.1%). Gastrointestinal toxicities, specifically nausea, diarrhea, and abdominal pain were worse in the cabozantinib arm.\n\n\nCONCLUSIONS\nMedian PFS was similar for cabozantinib and weekly paclitaxel. However, OS, EFS, and ORR were worse for cabozantinib compared to weekly paclitaxel. Cabozantinib given at this dose and schedule cannot be recommended as a treatment for recurrent ovarian cancer.