Would you consider first-line cabozantinib in patients with intermediate- or poor-risk mRCC?

Although the results from the phase II CABOSUN trial were intriquing, I would not consider cabozantinib as first line therapy for patients with intermediate or poor-risk mRCC. There were a number of concerning results. Firstly, the extremely low PFS of ~5months in the sunitinib-treated patients is much lower than prior clinical trials with sunitinib in this setting. Likewise, patients in the sunitinib arm were treated with a median of only 2 cycles which is much lower than generally seen in clinical practice. Moreover, close to 30% of the sunitinib-treated patients either never received sunitinib or were not evaluable for response given that they did not have post-baseline imaging.

Aside from the concerns with the sunitinib-treated patient...