• Camilo Jimenez, Mouhammed Amir Habra, Matthew T Campbell, Gina Tamsen, Damaris Cruz-Goldberg, James Long, Roland Bassett, Robert Dantzer, Vania Balderrama-Brondani, Jeena Varghese, and Yang Lu.
• Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. Electronic address: cjimenez@mdanderson.org.
• Lancet Oncol. 2024 May 1; 25 (5): 658667658-667.

BackgroundMetastatic phaeochromocytomas and paragangliomas (MPPGs) are orphan diseases. Up to 50% of MPPGs are associated with germline pathogenic variants of the SDHB gene. These tumours and many non-familial MPPGs exhibit a phenotype that is characterised by abnormal angiogenesis. We aimed to assess the activity and safety of cabozantinib, an antiangiogenic multi-tyrosine kinase inhibitor, in patients with MPPGs.MethodsThe Natalie Trial is a single-arm, phase 2 clinical trial being conducted at The University of Texas MD Anderson Cancer Center (Houston, TX, USA). Patients aged 18 years or older with histologically confirmed, progressive, and unresectable MPPGs, with an Eastern Cooperative Oncology Group performance status of 0-2, were treated with oral cabozantinib 60 mg/day. The primary endpoint was the investigator-assessed overall response rate per the Response Evaluation Criteria in Solid Tumours version 1.1 criteria. All outcomes were assessed in all evaluable participants who received any amount of study treatment. The trial is registered with ClinicalTrials.gov (NCT02302833) and is active but not recruiting.FindingsFrom March 10, 2015, to May 11, 2021, 17 patients (13 male participants and four female participants) were enrolled. The median follow-up was 25 months (IQR 18-49). The overall response rate was 25·0% (95% CI 7·3-52·4; four of 16 patients). Seven grade 3 adverse events were reported in six patients, including single cases of hand-and-foot syndrome, hypertension, rectal fistula, QT prolongation, and asymptomatic hypomagnesaemia, and two cases of asymptomatic elevations of amylase and lipase. There were no grade 4 adverse events and no patient died on-study.InterpretationCabozantinib shows promising activity in patients with MPPGs.FundingTeam NAT Foundation, Margaret Cazalot, and Clarence P Cazalot.© 2024 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.

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