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Dr Toni Choueiri speaks to ecancer about activity and biomarker analyses with casdatifan (cas), a next-generation HIF-2α inhibitor, in refractory clear cell renal cell carcinoma (ccRCC).
He reviews updated results from the phase one ARC-20 study evaluating Cas, a novel hypoxia-inducible factor 2 alpha inhibitor, in patients with heavily pretreated metastatic clear cell renal cell carcinoma.
Cas demonstrated encouraging clinical activity, with response rates around 30 to 35 percent and prolonged progression-free survival.
Notably, the drug produced rapid and sustained reductions in serum erythropoietin, a key biomarker of hypoxia-inducible factor pathway activity.
Greater reductions in this biomarker were associated with higher response rates and improved disease control, highlighting a potential link between target engagement and clinical benefit.
Treatment was generally well tolerated, with manageable side effects such as anaemia and low oxygen levels, and very low discontinuation rates.
These findings support Cas as a promising targeted therapy and reinforce the role of biomarker-driven approaches in advanced kidney cancer.
Casdatifan is another HIF-2 inhibitor that’s been tested in a large phase I study, a study of monotherapy dose escalation with an extended cohort at the MTD but also in combination with other drugs such as cabozantinib, which we presented before. In this presentation during GU ’26 we focussed on the totality of the data for monotherapy. It was a very large study for a phase I therapy and we saw activities across dosage.
Interestingly enough, also this builds on the strong translational arm of this phase I where we show a significant decrease in serum EPO. Think about it as a pharmacodynamic – more increase is better response rate. We also looked at EPO mRNA and other biomarkers, we looked at toxicity and there was nothing besides the anaemia, hypoxia known that are side effects of HIF=2 inhibitors.
Finally, what this is important to present is folks to be familiar with this drug because this drug is going into phase III trials. Actually we do have a phase III trial in combination with cabozantinib versus cabozantinib only in metastatic patients after immunotherapy, a study by the name PEAK-1. So hopefully the totality of the data will lead to embarking on accrual with PEAK-1 and finishing this study.
I think it’s good to have another HIF-2 inhibitor around, it’s good to have a choice and it’s good for patients.
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