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  • hbomb57108 hbomb57108 Feb 5, 2013 9:37 PM Flag

    Sunitinib-Induced Hemoglobin Changes Are Related to the Dosing Schedule

    Just that I overestimated the significance of cabo treated rise in hemoglobin. It appears that other vegfr therapies may demonstrate this same effect. The significance of this hemoglobin effect has dwindled in my mind over time. I originally thought the effect may be due to improved healthier bone marrow environment after cabo treatment. (In other words, crowding effect of tumor in bone marrow resulting in diminished red cells returning to a state of homeostasis or a more natural cancer free environment after cabo treatment) I am still very bullish on cabo prospects, but have tempered my enthusiasm over time. I am optimistic from small data sets in renal,hcc, and what we have seen thus far in prostate single arm trials, but I am also anxious to start seeing randomized comparator data.

    Ever since seeing those bone responses with sunitinib, I am looking that much harder from a skeptical point of view. No surprise that an agent other than Cabo would eventually show some type of drastic bone scan response, but took me by surprise that it was an agent that had been tested in a failed pivotal CRPC trial for survival. The phase 2 sunitinib vs cabo in first line renal has me very intrigued at the moment. My thoughts currently are that Cabo is more active in a variety of tumor indications than sunitinib, but I would also like to see real undeniable proof.

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    • "No surprise that an agent other than Cabo would eventually show some type of drastic bone scan response, but took me by surprise that it was an agent that had been tested in a failed pivotal CRPC trial for survival." Excuse me, but has sunitinib been shown to have "drastic bone scan response"? Or are you talking about another drug/treatment? Or are you extrapolating from the Hb effect?

      Joe

      • 2 Replies to joeflow77
      • Hi Joe, he is referring to the results of the following study which evaluated bone scan responses on 25 evaluable patients. There were 5 partial and 1 complete response. It should be noted that the criteria for a partial response was a 50% reduction in bone mets whereas EXEL has used a 30% criteria. So, allowing for small sample size and differing criteria for measuring, the sunitinib results are somewhat comparable to the Cabo's results. Worth noting is that Dr. Matt Smith is a coauthor of the sunitinib study and his exposure to the sunitinib results does not seem to have affected his enthusiasm for the Comet trials.

        JoeMultitargeted tyrosine kinase inhibition produces discordant changes between 99mTc-MDP bone scans and other disease biomarkers: analysis of a phase II study of sunitinib for metastatic castration-resistant prostate cancer.

      • Joe,

        Prior thread below this one, where I discuss the JNM article of post hoc bone scan images of sunitinib treated patients. This board sucks for linking data here as you know, but I did describe how you can pull images from that JNM article without subscription. My conclusion is that sunitinib bone scan responses are clearly not as consistently reproducible like cabo, but quite impressive regardless.

        I certainly wouldn't attempt any sort of extrapolation of hemoglobin response onto bone scan response.

    • $$$$

      "I am still very bullish on cabo prospects, but have tempered my enthusiasm over time."

      Hbomb, this made me laugh...
      I saw an old friend over Super Bowl weekend. We used to visit regularly, but life has redirected the both of us. He took a small position in EXEL a couple years ago on my reco...I wanna say he bought in around $5 - $5.25 PPS. Though it turned into a cool double for him, he hung onto the position, and thought but little of it till this recent visit. After he saw the current PPS, he was a bit taken... His first friendly words wrt EXEL were,
      "Would you remind me one more time WHY we bought into this...??"

      To which I replied, "Heck, yer the younger of the two of us, I was hopin' you'd recall."
      GL

      • 1 Reply to wilderguide
      • "I am still very bullish on cabo prospects, but have tempered my enthusiasm over time."

        "Hbomb, this made me laugh...
        I saw an old friend over Super Bowl weekend. We used to visit regularly, but life has redirected the both of us. He took a small position in EXEL a couple years ago on my reco...I wanna say he bought in around $5 - $5.25 PPS. Though it turned into a cool double for him, he hung onto the position, and thought but little of it till this recent visit. After he saw the current PPS, he was a bit taken... His first friendly words wrt EXEL were,
        "Would you remind me one more time WHY we bought into this...??"

        To which I replied, "Heck, yer the younger of the two of us, I was hopin' you'd recall."
        GL"

        I hear ya, my old friend decided to call it quits after "Would you remind me one more time WHY we bought into this...??"

        Sigh, he may just be the smart one.-----lol hope not

    • Thank you hbomb.

      Sentiment: Strong Buy

 
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