Cometriq (cabozantinib) vs Retsevmo (selpercatinib)

Cometriq (cabozantinib) and Retsevmo (selpercatinib) are both targeted therapies used to treat certain types of cancer, but they are approved for different indications and work through different mechanisms of action. Cometriq is a tyrosine kinase inhibitor that primarily targets MET, VEGFR, and RET proteins and is used for the treatment of medullary thyroid cancer and advanced renal cell carcinoma. Retsevmo, on the other hand, is a selective RET kinase inhibitor specifically designed for cancers with RET alterations, including RET fusion-positive non-small cell lung cancer, RET-mutant medullary thyroid cancer, and advanced solid tumors with RET fusions. A healthcare provider would consider the specific type of cancer, the presence of certain genetic mutations, and the patient's overall health status when deciding between these two medications.

Difference between Cometriq and Retsevmo

Metric	Cometriq (cabozantinib)	Retsevmo (selpercatinib)
Generic name	Cabozantinib	Selpercatinib
Indications	Medullary thyroid cancer, advanced renal cell carcinoma, and hepatocellular carcinoma	RET fusion-positive non-small cell lung cancer, RET-mutant medullary thyroid cancer, and RET fusion-positive thyroid cancer
Mechanism of action	Tyrosine kinase inhibitor that targets MET, VEGFR, and RET	Tyrosine kinase inhibitor that selectively targets RET alterations
Brand names	Cometriq, Cabometyx	Retsevmo
Administrative route	Oral	Oral
Side effects	Diarrhea, palmar-plantar erythrodysesthesia syndrome, decreased weight, decreased appetite, nausea, fatigue, oral pain, hair color changes, dysgeusia, hypertension, abdominal pain	Increased AST/ALT, increased glucose, decreased leukocytes, decreased albumin, decreased calcium, dry mouth, diarrhea, increased creatinine, hypertension, fatigue, edema, rash, pyrexia, constipation
Contraindications	Hypersensitivity to cabozantinib or any of its components	Hypersensitivity to selpercatinib or any of its components
Drug class	Tyrosine kinase inhibitor	Tyrosine kinase inhibitor
Manufacturer	Exelixis, Inc.	Eli Lilly and Company

Efficacy

Cometriq (Cabozantinib) for Thyroid Cancer

Cometriq, known generically as cabozantinib, is a medication that has shown efficacy in the treatment of progressive, metastatic medullary thyroid cancer (MTC). Cabozantinib is a tyrosine kinase inhibitor that targets multiple receptors, which are involved in the pathogenesis of thyroid cancer, including RET, MET, and VEGFR. The efficacy of Cometriq in thyroid cancer was evaluated in a phase III clinical trial known as EXAM, which demonstrated that cabozantinib significantly improved progression-free survival compared to placebo. This improvement in progression-free survival indicates that Cometriq can delay the progression of thyroid cancer in patients with metastatic MTC, which is a rare form of thyroid cancer.

The EXAM trial showed that the median progression-free survival was 11.2 months for patients treated with Cometriq, compared to 4.0 months for those receiving placebo. This represents a substantial improvement and provides a treatment option for patients with few alternatives. However, it is important for patients and healthcare providers to consider the potential side effects and to monitor for adverse reactions during treatment with Cometriq.

Retsevmo (Selpercatinib) for Thyroid Cancer

Retsevmo, with the generic name selpercatinib, is another targeted therapy that has demonstrated efficacy in the treatment of certain types of thyroid cancers. Specifically, it is approved for the treatment of adult and pediatric patients 12 years of age and older with advanced or metastatic RET-mutant medullary thyroid cancer (MTC) who require systemic therapy. Selpercatinib is a selective RET kinase inhibitor, and its approval was based on the results of the LIBRETTO-001 trial, which showed significant antitumor activity in patients with RET-driven thyroid cancers.

In the LIBRETTO-001 trial, selpercatinib achieved an objective response rate (ORR) of 69% in patients with RET-mutant medullary thyroid cancer who had been previously treated with cabozantinib or vandetanib, two other kinase inhibitors. For treatment-naive patients, the ORR was 73%. These results indicate that Retsevmo is highly effective in shrinking tumors in a significant proportion of patients with RET-mutant MTC. As with any medication, the use of Retsevmo should be balanced with an awareness of potential side effects, and treatment should be managed by a healthcare provider experienced in the use of anticancer therapies.

Regulatory Agency Approvals

Cometriq

European Medical Agency (EMA), European Union
Food and Drug Administration (FDA), USA

Retsevmo

European Medical Agency (EMA), European Union
Food and Drug Administration (FDA), USA

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