Analyst Outlook
Cometriq (cabozantinib; Exelixis) is likely to be approved as a second-line therapy for patients with
advanced renal cell cancer (RCC), however, uptake will be dampened by the presence of programmed
death-1 (PD-1) inhibitor Opdivo (nivolumab; Bristol-Myers Squibb/Ono Pharmaceutical), which looks
set to become the standard of care in this setting. Inability to show a significant increase in overall
survival (OS) in patients treated with Cometriq versus the current standard of care means that
Cometriq is likely to be chosen behind Opdivo in the RCC treatment paradigm, and used in the third-
line setting as a salvage chemotherapy.
Drug Overview
Cometriq is an orally available small molecule inhibitor currently being developed by Exelixis as
second-line therapy for patients with relapsed or metastatic RCC. Cometriq has been shown to
suppress tumour growth and metastasis by inhibiting the activity of multiple tyrosine kinases
including MET, AXL, and vascular endothelial growth factor receptors (VEGFR). Vascular endothelial
growth factor (VEGF) production is upregulated in RCC and results in increased tumor vascularization
and disease progression. Standard first-line therapies such as Sutent (sunitinib; Pfizer) work by
targeting VEGF/VEGFR signalling; however, tumors often develop resistance to these anti-angiogenic
treatments. Aberrant expression of MET and AXL tyrosine kinases is associated with drug resistance
and poor disease prognosis; by targeting MET and AXL as well as VEGF/VEGFR signalling, Cometriq
may provide an alternative treatment option for patients in the relapsed setting (Choueiri et al., 2015).
TABLE OF CONTENTS
4 PRODUCT PROFILES
4 Cometriq : Renal cell cancer
11 Cometriq : Hepatocellular cancer
LIST OF FIGURES
6 Figure 1: Cometriq for renal cell cancer – SWOT analysis
7 Figure 2: Datamonitor Healthcare’s drug assessment summary for Cometriq in renal cell
cancer
8 Figure 3: Datamonitor Healthcare’s drug assessment summary for Cometriq in renal cell
cancer
13 Figure 4: Phase II RDT of Cometriq in hepatocellular cancer – trial design
14 Figure 5: Cometriq’s SWOT analysis for hepatocellular cancer
15 Figure 6: Datamonitor Healthcare’s drug assessment summary for Cometriq in hepatocellular
cancer
16 Figure 7: Datamonitor Healthcare’s drug assessment summary for Cometriq in hepatocellular
cancer
LIST OF TABLES
4 Table 1: Cometriq drug profile
5 Table 2: Cometriq Phase III trials in renal cell cancer
11 Table 3: Cometriq – drug profile
12 Table 4: Phase III pivotal study of Cometriq in hepatocellular cancer
13 Table 5: Results from Phase II RDT of Cometriq in hepatocellular cancer