How effective is cabozantinib in treating kidney and liver cancer? Full analysis of price differences and domestic and foreign drug purchase channels

1. Medical hot spots: multi-targetsTKIClinical breakthroughs in drugs

In recent years, targeted tumor therapy has entered the era of "multi-target inhibition". Cabozantinib (Cabozantinib) has become a global focus due to its remarkable efficacy in the treatment of kidney cancer, liver cancer, thyroid cancer and other malignant tumors. Especially in the context of the trend of immune combination therapy, the research results of cabozantinib combined with PD-1/PD-L1 inhibitors continue to refresh clinical data.

At2023ASCO annual meeting, cabozantinib combined with nivolumab (Nivolumab) was effective in advanced renal cell carcinoma (RCC) In first-line treatment, it has shown better overall survival (OS) and progression-free survival (PFS) data than sunitinib, which has attracted widespread attention in the oncology community. This not only establishes the core position of cabozantinib in the treatment of RCC, but also promotes its research and exploration in other indications.

2. The mechanism of action and clinical application of cabozantinib

1. drug action mechanism

Cabotinib is an oral multi-target tyrosine kinase inhibitor (TKI) that mainly inhibits VEGFR, MET, AXL, RET and other signaling pathways. These pathways are widely involved in the angiogenesis, invasion, metastasis and drug resistance mechanisms of tumor cells. Therefore, cabozantinib can not only inhibit tumor growth, but also reverse drug resistance problems related to the tumor microenvironment, providing a theoretical basis for combination therapy.

2. Core indications and clinical data

Renal cell carcinoma (RCC): In the CheckMate 9ER trial, cabozantinib plus nivolumab significantly improved patient median PFS compared with sunitinib (16.6 months vs. 8.3 months), the objective response rate (ORR) reached 55.7%, and the overall survival risk was reduced by 40%.

Hepatocellular carcinoma (HCC): inCELESTIAL In a phase III study, cabozantinib was used in patients with advanced HCC who had previously received sorafenib treatment, and the median OS was extended to 10.2 months (control group 8.0 months), and a 24% risk reduction.

Medullary thyroid cancer (MTC): Caboozantinib is one of the first targeted drugs approved by the FDA for advanced MTC. The study showed that the median PFS reached 11.2 months, which was significantly better than that of the placebo group (4.0 months), and the objective response rate exceeded 25%.

Other exploratory indications: Including prostate cancer, ovarian cancer, non-small cell lung cancer (NSCLC), etc., which are still in different stages of clinical research and show good potential.

3. Safety and Side Effects

Common adverse reactions include: hypertension, hand-foot syndrome, diarrhea, fatigue, loss of appetite, etc. Most patients can tolerate it through dose adjustment or supportive treatment, and the overall safety is controllable.

3. Global listing and price situation

1.Domestic listing situation

At present, cabozantinib has not yet been officially launched in mainland China, so patients must rely on formal overseas channels if they need to use it. As the introduction of drugs into China accelerates, the industry expects that the drug will enter the domestic market as soon as possible in the future.

2. Overseas price information

The original drug (Exelixis): has been launched in Europe, Japan, Hong Kong, Macao, Taiwan and Türkiye. Different specifications (20mg 90 capsules, 60mg 30 capsules, 80mg*30 capsules) are sold for about forty to fifty thousand yuan.

Generic drugs: Generic drugs have been launched in markets such as Laos and Bangladesh. Common specifications include 20mg 90 tablets, 60mg 30 tablets, 80mg*30 tablets, and the prices are between 500~1000More than yuan The ingredients of the drug are basically the same as the original drug.

3. Price Differences and Patient Selection

For patients, original drugs are more secure in terms of drug quality, production supervision and clinical verification, but they are expensive. Generic drugs have obvious price advantages and are more suitable for long-term drug users. It is recommended that patients choose regular channels to purchase drugs under the guidance of doctors and combined with their own financial conditions, and avoid purchasing drugs from unknown sources.

4. Frequently Asked Questions and Medication Concerns of Patients

1. Which patients is cabozantinib suitable for?

Applicable to Advanced renal cell carcinoma, advanced liver cancer, medullary thyroid cancer , etc., and some other solid tumors are in the research stage.

2. How long does it take for the medication to take effect?

Some patients may see tumor shrinkage or disease stabilization within 8~12 weeks. The specific effect varies between individuals.

3. Can it be taken for a long time?

Cabotinib is usually used as a long-term treatment drug, but it needs to be monitored Liver and kidney function, blood pressure and thyroid function, and the dose should be adjusted regularly under the guidance of a doctor.

4. How to reduce the financial burden?

Generic drugs can be obtained through regular overseas pharmacies, cross-border medical institutions, or by applying for international charity assistance projects. With the popularity of generic drugs around the world, the burden on patients is expected to be further reduced in the future.

5. Future Prospects: Immunity+The Prospects of Targeted Combination

As clinical research on immunotherapy+targeted therapy continues to deepen, cabozantinib has shown significant potential in combination therapy. It can not only improve the immune microenvironment and improve the efficacy of PD-1/PD-L1 inhibitors, but may also delay the occurrence of drug resistance. In the future, cabozantinib is expected to occupy a core position in multiple cancer treatment strategies, especially in the clinical application of first-line combination drugs, which will further benefit more patients.

6. Summary

Caboozantinib, as a multi-targetTKI inhibitor, has shown significant efficacy in a variety of malignant tumors such as kidney cancer, liver cancer, and thyroid cancer. Although it has not yet been launched domestically, it has been widely used overseas. The original drugs are expensive (approximately 400,000 to 500,000 yuan), while generic drugs in Laos and Bangladesh only cost 500-1,000 yuan, which greatly alleviates the financial pressure on patients. With in-depth research and policy promotion, cabozantinib is expected to enter the market in more countries and regions in the future, providing patients with a more popular and affordable treatment option.

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References

1.NEJM: Cabozantinib in Advanced Hepatocellular Carcinoma (CELESTIAL trial)

2.ASCO 2023 Annual Meeting Abstracts: CheckMate 9ER Trial Updates

3.FDA Drug Database – Cabozantinib (Cabometyx/Cometriq) Approvals

4.Exelixis Official Website – Cabozantinib Clinical Data

5.China National Food and Drug Administration (NMPA) drug registration database