If I read this correctly - despite Vanetanib's clinical tenure - Cabo is currently being recognized as an equally effective therapeutic course in these 4 areas of recurrent MTC progression. I see this as a very strong sign of adoption, as this update was posted only 3 weeks following approval.
"•Medullary Thyroid Carcinoma
◦The page regarding "Medullary thyroid carcinoma diagnosed after initial thyroid surgery" was revised. (MEDU-2)
◦Recurrent or persistent disease (MEDU-6)
■Locoregional: "Cabozantinib (category 1)" was added as an option to consider. Vandetanib changed from category 2A to a category 1 recommendation.
■Symptomatic, distant metastasis: Vandetanib changed from category 2A to category 1, and the recommendation was modified as follows: "Consider vandetanib (category 1)". The following recommendation was added: "Consider cabozantinib (category 1)".
■Asymptomatic distant metastases: The recommendation was revised as follows: Consider resection (if possible), ablation (eg, RFA, embolization, or other regional therapy), or vandetanib (category 1), or cabozantinib (category 1) if structurally progressive disease". (vandetanib changed from category 2A to category 1 recommendation).
■Disseminated symptomatic disease: Vandetanib changed from category 2A to category 1. "Cabozantinib (category 1)" was added as a treatment option."
"...but what did not happen is the addition of Comet to the list of 3 TKI's recommended for use among the various forms of DTC."
Wouldn't that be expecting just a bit too much expediency from the FDA? Besides, as I understand the process, for off-label listing...mustn't the sponsor actually apply for consideration?
This initial update makes me optimistic for further Thyroid considerations pending the March annual meeting. I still think DTC can fly. Besides, Cabo's marketing ace-in-the-hole bone phenom is going to make it the anti-angiogenic of prescription choice, if mets are a concern.