Interpreting the Broad Cabozantinib Label for NETs
Key Points
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Based on findings from the CABINET trial, cabozantinib was approved for previously treated pancreatic and extrapancreatic neuroendocrine tumors (NETs).
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Cabozantinib’s broad label gives physicians flexibility when treating patients who don’t match the exact eligibility criteria.
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Gastrointestinal oncology experts weigh in on real-world use of cabozantinib in advanced pancreatic NETs.
At the 2025 American Society of Clinical Oncology (ASCO) Annual Meeting, Shruti Patel, MD, of Stanford Medicine, and Neena Vijayvergia, MD, of Fox Chase Cancer Center, discussed cabozantinib for advanced pancreatic and extrapancreatic NETs.
Dr. Patel asked Dr. Vijayvergia how she interprets the broad “previously treated” indication given to cabozantinib after its approval based on the pivotal CABINET trial.
In the trial, the extrapancreatic NET group had previously received a somatostatin analogue (SSA) plus either peptide receptor radionuclide therapy (PRRT) or everolimus, and the pancreatic NET group had previously received a SSA plus one of PRRT, everolimus, capecitabine-temozolomide, or sunitinib.
“That’s how National Comprehensive Cancer Network Guidelines have approved it, and that’s how I use it—in patients who have had one therapy in addition to SSA, so ‘third-line’ you could say,” Dr. Vijayvergia said.
However, she noted the broad indication allows cabozantinib to be used outside of patients who strictly meet the CABINET criteria. For example, as a second-line treatment in patients who can not receive radioligand therapy.
Overall, the FDA uses broad labels to allow physicians and providers flexibility to decide when to use new therapies, Dr. Vijayvergia said.