Impact of cabozantinib on plasma adrenocorticotropic hormone and serum cortisol

Overview

Expand on the patient demographics and the clinical significance of elevated ACTH levels.

Background

Tyrosine kinase inhibitors (TKIs) like cabozantinib are crucial in treating metastatic renal cell carcinoma but can lead to adverse effects, including fatigue and anorexia. Recent reports suggest that TKIs may cause primary adrenal insufficiency (PAI), which can significantly impact patient quality of life. Understanding the effects of cabozantinib on adrenal function is essential for optimizing patient management.

Data Highlights

Key Findings

• Cabozantinib was associated with elevated plasma ACTH levels in some patients.
• Patients with elevated ACTH levels exhibited symptoms consistent with primary adrenal insufficiency.
• Glucocorticoid replacement therapy improved symptoms in patients diagnosed with PAI.
• Regular monitoring of adrenal function is not currently recommended for TKI therapy, unlike ICI therapy.
• Adrenocortical function was assessed using the ACTH stimulation test, which is the gold standard for diagnosing PAI.

Clinical Implications

Healthcare providers should be aware of the potential for cabozantinib to induce primary adrenal insufficiency, particularly in patients exhibiting symptoms of fatigue or anorexia. Monitoring plasma ACTH and serum cortisol levels may be warranted in symptomatic patients to facilitate timely diagnosis and management.

Conclusion

The findings suggest that cabozantinib can affect adrenal function, leading to elevated ACTH levels and potential adrenal insufficiency. Further studies are needed to clarify the implications of these effects in clinical practice.

References

1. The ASCO Post, 2019 -- Retrospective Study Evaluates Cabozantinib in Advanced Non–Clear Cell Renal Cell Carcinoma
2. The ASCO Post, 2019 -- Pembrolizumab/Cabozantinib Shows Activity in Previously Treated Renal Cell Carcinoma
3. The ASCO Post, 2016 -- Cabozantinib Improves Progression-Free Survival and Response Rates vs Sunitinib in First-Line Treatment of Metastatic Kidney Cancer
4. ScienceDirect, 2024 -- Renal cell carcinoma: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up
5. The ASCO Post — Cabozantinib and Atezolizumab in Metastatic Castration-Resistant Prostate Cancer
6. Management of adverse events associated with cabozantinib plus nivolumab in renal cell carcinoma: A review
7. Determination of cortisol cut-off limits and steroid dynamics in the ACTH stimulation test
8. Renal cell carcinoma: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up - ScienceDirect