Cabozantinib in combination with immune checkpoint inhibitors for renal cell carcinoma: a systematic review and meta-analysis

Jingyang Su; Jialin Zhang; Yuqian Wu; Cui Ni; Yueyue Ding; Zelin Cai; Ming Xu; Mingyang Lai; Jue Wang; Shengyou Lin; Jinhua Lu

doi:10.3389/fphar.2024.1322473

Cabozantinib in combination with immune checkpoint inhibitors for renal cell carcinoma: a systematic review and meta-analysis

Front Pharmacol. 2024 Apr 17:15:1322473. doi: 10.3389/fphar.2024.1322473. eCollection 2024.

Authors

Jingyang Su^#^{1

2}, Jialin Zhang^#¹, Yuqian Wu^#³, Cui Ni^#¹, Yueyue Ding², Zelin Cai¹, Ming Xu⁴, Mingyang Lai¹, Jue Wang¹, Shengyou Lin⁵, Jinhua Lu¹

Affiliations

¹ Department of Oncology, Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Hangzhou, China.
² Tongde Hospital of Zhejiang Province, Hangzhou, China.
³ Zhejiang Chinese Medical University, Hangzhou, China.
⁴ Department of Traditional Chinese Medicine, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.
⁵ Department of Oncology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.

^# Contributed equally.

Abstract

Context: Cabozantinib combined with immune checkpoint inhibitors (ICIs) has brought a new therapeutic effect for the medical treatment of renal cell carcinoma (RCC).

Objectives: We performed a meta-analysis of randomized controlled trials and single-arm trials to evaluate the efficacy and safety of cabozantinib plus ICIs in RCC.

Methods: We extracted data from PubMed, Cochrane, Medline and Embase databases, and rated literature quality through Cochrane risk of bias tool and MINORS. RevMan5.3 software was used to analyze the results of randomized controlled trials and single-arm trials.

Results: A total of 7 studies were included. Treatment with cabozantinib plus ICIs improved PFS [HR 0.75, (95%CI: 0.52, 1.08), p = 0.12] and the OS [HR 0.80, (95%CI: 0.60, 1.07), p = 0.13] in randomized controlled trials. Meanwhile, the result of the ORR in randomized controlled trials was [risk ratio (RR) 1.37, (95%CI: 1.21, 1.54), p < 0.00001] and in single-arm trials was [risk difference (RD) 0.49, (95%CI: 0.26, 0.71), p < 0.0001].

Conclusion: Cabozantinib plus ICIs prolonged the PFS and OS, and improved ORR in patients with RCC. Our recommendation is to use cabozantinib plus ICIs to treat advanced RCC, and to continuous monitor and manage the drug-related adverse events.

Systematic review registration: identifier CRD42023455878.

Keywords: adverse events; cabozantinib; immune checkpoint inhibitors; renal cell carcinoma; tyrosine kinase inhibitors.

Publication types

Systematic Review

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. 1. The Construction Fund of Medical Key Disciplines of Hangzhou. Oncology Therapeutics (Joint Unit), platform code (OO20200385); Expense reimbursement (2020SJZDXK04). 2. Zhejiang Lin Shengyou famous Traditional Chinese Medicine expert inheritance studio project (GZS202002).