CABINET (Alliance A021602)
Cabozantinib tripled the time without progression in neuroendocrine tumours that had outgrown other treatments, leading to a 2025 approval.
Overview
CABINET, Alliance trial A021602, NCT03375320, sponsored by the Alliance, the NCI and Exelixis and reported in the New England Journal of Medicine in 2024, showed that cabozantinib roughly tripled the time without progression in neuroendocrine tumours that had outgrown other treatments, leading to FDA approval in March 2025. It randomised 298 patients in separate pancreatic and extra-pancreatic cohorts to cabozantinib or placebo and met its primary progression-free survival endpoint in both, with an ESMO 2025 subgroup analysis showing a large reduction in progression risk in lung and thymic tumours. Nuclide links it to neuroendocrine tumours, cabozantinib and the Alliance for Clinical Trials in Oncology. Whether cabozantinib's benefit holds against, or in sequence with, radioligand therapy is the open question.
- Median 13.8 vs 4.4 months with Cabozantinib compared with Placebo; about 9.4 months longer for half the group.
- A median is a midpoint: half the people did better than this and half did worse, so it is not a prediction for any one person.
- Put another way, the treated group had about 77 percent lower chance of the event at any given time (hazard ratio 0.23, likely range 0.12 to 0.42).
- Median 8.4 vs 3.9 months with Cabozantinib compared with Placebo; about 4.5 months longer for half the group.
- A median is a midpoint: half the people did better than this and half did worse, so it is not a prediction for any one person.
- Put another way, the treated group had about 62 percent lower chance of the event at any given time (hazard ratio 0.38, likely range 0.25 to 0.59).
- This is a surrogate endpoint: it measures the cancer being controlled or absent on scans and tests, which often, but not always, translates into living longer.
- These results apply to the people the trial enrolled: Previously treated advanced pancreatic (n=95) and extra-pancreatic (n=203) NETs: cabozantinib vs placebo. People in a different situation may not see the same effect.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
298 enrolled.
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