Cabozantinib, a receptor tyrosine kinase inhibitor (TKI) with activity against a broad range of targets, has shown survival benefit as first-line systemic therapy for patients with advanced renal cell carcinoma (RCC). Currently, both Cabozantinib used alone and its combination with the programmed death 1 (PD-1) immune checkpoint inhibitor Nivolumab are recommended regimens for systemic therapy for clear cell renal cell carcinoma (ccRCC) in the NCCN guideline. Here, we would like to present our experiences.

Patients with ccRCC who were treated with Cabozantinib, with or without Nivolumab, as first-line systemic therapy at Taipei Veterans General Hospital were reviewed from October 2020 to September 2024. The patients were regularly followed up with blood tests and imaging studies, including either computed tomography, sonography, magnetic resonance imaging, and whole body bone scan every 3 months. Clinical parameters, including demographics, clinical staging, IMDC risk score, and surgical pathology details were collected. The main outcome was progression-free survival (PFS). Overall survival (OS), sites of progression, and adverse events were also evaluated.

A total of 21 patients were treated with Cabozantinib as first-line therapy for ccRCC. Among them, 14 were combined with Nivolumab. The mean age was 68.5±8.89 (Range 48.7-86.0) years. The patients were followed for a median of 32.13 months (IQR 16.03-40.53). The median PFS was 15.37 months (IQR 11.13-31.13) for all patients, and 21.10 months (IQR 11.13-36.80) for patients receiving Cabozantinib and Nivolumab. The median PFS for the Cabozantinib alone group was not reached. Eight patients (38.1%) experienced adverse events of any cause, with grade 3 or higher severity, most frequently an abnormal liver function test (3 patients). Disease progression occurred in 10 patients (47.6%), with progression of lung metastasis being the most frequent site of progression (3 patients). The median OS for all patients was 33.13 months (IQR 17.63-43.47).

Our experiences provided real-world outcomes of Cabozantinib as first-line therapy for ccRCC in the Taiwanese population, which was comparable to previous reports. Longer-term follow-up and a larger patient cohort could further clarify the effectiveness of Cabozantinib.