Cabozantinib: Uses, Dosage, and Side Effects Overview

Summary of Key Points

Cabozantinib is a prescription medication used to treat several types of cancer, including kidney, liver, and thyroid cancers. It works by blocking proteins that encourage cancer cell growth. Cabozantinib is typically taken as a tablet or capsule and should always be used under the guidance of a healthcare provider. Common side effects include fatigue, diarrhea, and high blood pressure. Always consult your doctor before starting or adjusting your dose.

Names of Medication

US Brand Name: Cabometyx (Cabozantinib)

US Brand Name: Cometriq (Cabozantinib)

The generic name refers to the active ingredient, while the brand name is assigned by the manufacturer. The generic name is listed in parentheses.

Pharmacologic Category

Tyrosine Kinase Inhibitor

Vascular Endothelial Growth Factor (VEGF) Inhibitor

Cabozantinib Dosage

Cabozantinib is prescribed to treat various cancers in adults. The dosage may vary depending on the specific condition being treated. Always follow your healthcare provider’s instructions and consult them before making any changes to your dose. You can also schedule a telemedicine appointment with one of our providers to discuss your treatment plan.

Cabozantinib for Kidney Cancer (Renal Cell Carcinoma)

The recommended dose is 60 mg taken orally once daily. Treatment continues until the disease progresses or side effects become intolerable.

Cabozantinib for Liver Cancer (Hepatocellular Carcinoma)

The usual dose is 60 mg taken orally once daily. The duration of treatment depends on how well the cancer responds to the medication.

Cabozantinib Treatment for Thyroid Cancer

For patients with medullary thyroid cancer, the recommended dose is 140 mg taken orally once daily (Cometriq). Treatment continues until the disease progresses or side effects become unmanageable.

Cabozantinib for Neuroendocrine Tumors

The typical dose is 60 mg taken orally once daily. The length of treatment varies based on the patient’s response to the medication.

Cabozantinib for Bladder Cancer

The recommended dose is 60 mg taken orally once daily. Treatment continues until the disease progresses or side effects become intolerable.

Cabozantinib for Gastric Cancer (Stomach Cancer)

The usual dose is 60 mg taken orally once daily. The duration of treatment depends on the patient’s response to therapy.

Cabozantinib for Colorectal Cancer

The dose is 60 mg taken orally once daily. Treatment continues until the disease progresses or side effects become too severe.

Cabozantinib for Pancreatic Cancer

The recommended dose is 60 mg taken orally once daily. The length of treatment depends on the patient’s response to the medication.

Cabozantinib for Lung Cancer

The usual dose is 60 mg taken orally once daily. Treatment continues until the disease progresses or side effects become intolerable.

Cabozantinib for Head and Neck Cancer

The dose is 60 mg taken orally once daily. The duration of treatment varies depending on the patient’s response to therapy.

Dosage Forms and Strengths

Tablets: 20 mg, 40 mg, 60 mg (Cabometyx)

Capsules: 20 mg, 80 mg (Cometriq)

Administration Instructions for Cabozantinib

Cabozantinib should be taken on an empty stomach, at least 1 hour before or 2 hours after eating. Swallow the tablets or capsules whole with water. Do not crush, chew, or break the tablets. It is important to take this medication at the same time each day. If you miss a dose, take it as soon as you remember, unless it is close to your next scheduled dose. Do not take two doses at once.

Cabozantinib Side Effects and Adverse Reactions

Like all medications, Cabozantinib can cause side effects. Some are more common, while others are rare but serious. It’s important to discuss any side effects with your healthcare provider, especially if they become severe. You can also consult one of our providers through telemedicine for advice.

Common Cabozantinib Side Effects

Fatigue: Feeling unusually tired or weak is common and may improve with rest.

Diarrhea: Loose or frequent bowel movements can occur. Stay hydrated and consult your doctor if it becomes severe.

High Blood Pressure (Hypertension): Cabozantinib may cause elevated blood pressure, which should be monitored regularly.

Loss of Appetite: Some patients may experience reduced hunger or difficulty eating.

Serious Cabozantinib Side Effects

Bleeding: Cabozantinib can increase the risk of bleeding, especially in the stomach or intestines. Seek medical attention if you notice blood in your stool or vomit.

Blood Clots: This medication may increase the risk of developing blood clots, which can lead to serious complications like stroke or heart attack.

Gastrointestinal Perforation: In rare cases, Cabozantinib can cause holes in the stomach or intestines, which is a medical emergency.

Contraindications for Cabozantinib

A contraindication is a specific situation or condition where a particular medication should not be used because it may be harmful to the patient. If you have any of the conditions listed below, Cabozantinib may not be safe for you. Always discuss your full medical history with your healthcare provider before starting any new medication.

Allergic Reaction to Cabozantinib

If you have had an allergic reaction to Cabozantinib in the past, you should not take this medication. Allergic reactions can range from mild rashes to more severe symptoms like difficulty breathing or swelling.

Severe Liver Disease

Cabozantinib is processed by the liver, and if you have severe liver disease, your body may not be able to handle the medication properly, leading to increased side effects or toxicity.

Recent Surgery or Open Wounds

Cabozantinib can impair wound healing, so it is contraindicated in patients who have had recent surgery or who have open wounds. Taking the medication in these cases could delay recovery or increase the risk of complications.

Uncontrolled High Blood Pressure (Hypertension)

Cabozantinib can raise blood pressure, so it is not recommended for patients whose blood pressure is not well-controlled. High blood pressure can increase the risk of heart problems or stroke while on this medication.

History of Gastrointestinal (GI) Perforation or Fistula

Cabozantinib has been associated with an increased risk of GI perforation (a hole in the stomach or intestines) or fistula (an abnormal connection between organs). If you have a history of these conditions, taking Cabozantinib could increase your risk of recurrence.

Drug to Drug Interactions with Cabozantinib

Cabozantinib can interact with other medications, potentially increasing side effects or reducing the effectiveness of either Cabozantinib or the other drugs. It is crucial to inform your healthcare provider about all medications you are taking, including over-the-counter drugs and supplements. Below are some medications that may interact with Cabozantinib:

1. Ketoconazole (Nizoral): This antifungal medication can elevate Cabozantinib levels in your body, increasing the risk of side effects.
2. Rifampin (Rifadin): This antibiotic can reduce Cabozantinib’s effectiveness by lowering its concentration in your body.
3. Phenytoin (Dilantin): This anti-seizure medication can decrease Cabozantinib’s effectiveness by speeding up its breakdown in the liver.
4. St. John’s Wort: This herbal supplement can reduce Cabozantinib’s effectiveness by enhancing its breakdown in the liver.
5. Warfarin (Coumadin): Cabozantinib may increase the risk of bleeding when taken with blood thinners like Warfarin.

Cabozantinib and Pregnancy

Cabozantinib is not safe during pregnancy, as it can harm an unborn baby and lead to birth defects or other serious complications. If you are pregnant or planning to become pregnant, you should avoid taking Cabozantinib. Women of childbearing age should use effective contraception while on this medication and for at least 4 months after stopping it. If you become pregnant while taking Cabozantinib, contact your healthcare provider immediately.

Cabozantinib while Breastfeeding

Cabozantinib is not recommended during breastfeeding. Although it is unclear whether Cabozantinib passes into breast milk, the potential for serious side effects in a nursing infant is significant. Therefore, breastfeeding should be avoided during treatment and for at least 4 months after the last dose. If you are breastfeeding or planning to breastfeed, consult your healthcare provider for alternative options.

Estimated Cost of Cabozantinib

The estimated cost of a 30-day supply of Cabozantinib (typically 60 mg tablets) without insurance ranges from $15,000 to $18,000, depending on the pharmacy. Using a GoodRx coupon, the price may drop to around $14,000 to $16,000 for a 30-day supply. Prices can vary, so it’s advisable to check with your pharmacy or use a discount program like GoodRx to find the best available price.

Possible Alternatives to Cabozantinib

Depending on the type of cancer being treated, alternative treatments or lifestyle changes may be available. Always discuss these options with your healthcare provider before making any changes to your treatment plan. Our telemedicine providers are available to help you explore these alternatives.

1. Renal cell carcinoma: Alternatives include other targeted therapies like Sunitinib (Sutent) or Pazopanib (Votrient), as well as immunotherapy options like Nivolumab (Opdivo). Lifestyle changes such as maintaining a healthy diet and regular exercise may also support overall well-being during treatment.
2. Hepatocellular carcinoma: Sorafenib (Nexavar) and Lenvatinib (Lenvima) are other targeted therapies that may be considered. Reducing alcohol intake and managing liver health through diet and exercise can also be beneficial.
3. Thyroid cancer: Other treatment options may include Vandetanib (Caprelsa) or Lenvatinib (Lenvima). Regular monitoring of thyroid hormone levels and maintaining a balanced diet can support overall health.
4. Neuroendocrine tumors: Everolimus (Afinitor) and Sunitinib (Sutent) are potential alternatives. Dietary changes, such as reducing sugar intake, may help manage symptoms.
5. Bladder cancer: Immunotherapy options like Atezolizumab (Tecentriq) or Pembrolizumab (Keytruda) may be considered. Quitting smoking and staying hydrated are important lifestyle changes.
6. Gastric cancer: Ramucirumab (Cyramza) or Trastuzumab (Herceptin) may be alternatives. A diet rich in vegetables and low in processed foods may support overall health.
7. Colorectal cancer: Bevacizumab (Avastin) or Cetuximab (Erbitux) are possible alternatives. Regular physical activity and a high-fiber diet may help improve overall health.
8. Pancreatic cancer: FOLFIRINOX (a combination of chemotherapy drugs) or Gemcitabine (Gemzar) may be alternatives. Maintaining a healthy weight and avoiding smoking can be beneficial.
9. Lung cancer: Pembrolizumab (Keytruda) or Atezolizumab (Tecentriq) may be considered. Quitting smoking and regular exercise can improve lung health.
10. Head and neck cancer: Cetuximab (Erbitux) or Pembrolizumab (Keytruda) may be alternatives. Avoiding alcohol and tobacco use can help reduce the risk of complications.

Recent Updates on Cabozantinib Research

Recent studies show that Cabozantinib remains a promising treatment for various cancers, especially in combination with other therapies. For example, ongoing research is exploring the use of Cabozantinib with immunotherapy drugs like Nivolumab (Opdivo) for renal cell carcinoma, showing improved outcomes in some patients. Additionally, studies are investigating its effectiveness in treating other cancers, such as prostate cancer and non-small cell lung cancer. While these studies are still ongoing, early results are encouraging.

As research progresses, new information about Cabozantinib’s safety and effectiveness may emerge. Stay in touch with your healthcare provider to learn about the latest treatment options. If you have any questions about your treatment plan, our telemedicine providers are here to help you navigate your options.

James Kingsley

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