Cabozantinib

• Advanced renal cell carcinoma (kidney cancer): as a first treatment in patients with intermediate or poor risk disease, or after previous VEGF-targeted therapy.
• Hepatocellular carcinoma (liver cancer): in patients previously treated with sorafenib.

When should one not use Cabozantinib

• If you are allergic (hypersensitive) to cabozantinib or any other ingredient of Cabozantinib.

Common side effects of this drug are:

• Very common side effects:
• Diarrhoea
• Fatigue, weakness, and mucosal inflammation
• Hand-foot syndrome (palmar-plantar erythrodysaesthesia), causing redness, pain, swelling, or blistering on the palms and soles
• Nausea, vomiting, and mouth sores (stomatitis)
• Constipation, indigestion, and abdominal pain
• Decreased appetite and weight loss
• High blood pressure (hypertension)
• Bleeding (haemorrhage)
• Low blood counts (anaemia, low platelets, )
• Underactive thyroid (hypothyroidism)
• Changes in taste (dysgeusia), headache, and dizziness
• Hoarseness or voice changes (dysphonia), breathlessness, and cough
• Skin rash
• Raised liver enzymes (ALT/AST)
• Pain in the arms or legs, and swelling of the hands or feet (peripheral oedema)
• Other commonly reported side effects:
• Dehydration
• Muscle spasms and joint pain
• Protein in the urine (proteinuria)
• Dry mouth, oral pain, and difficulty swallowing
• Itching, dry skin, hair colour change, and hair thinning
• Blood clots in the veins (including the lungs)
• Hepatic encephalopathy (confusion due to liver problems, seen in liver cancer patients)
• Changes in blood sugar, calcium, sodium, or bilirubin on blood tests
• Serious side effects requiring immediate medical attention:
• Serious or life-threatening bleeding: contact your doctor immediately if you cough up blood, vomit blood or material that looks like coffee grounds, pass red or black tarry stools, or have unusually heavy bleeding of any kind.
• A tear in the stomach or intestine (perforation) or an abnormal connection between organs (fistula): seek urgent care for new, severe, or persistent abdominal pain.
• Blood clots, heart attack, or stroke: get emergency help for chest pain, sudden breathlessness, swelling or pain in a limb, sudden weakness or numbness, trouble speaking, or a sudden severe headache.
• Hypertensive crisis: dangerously high blood pressure.
• Osteonecrosis of the jaw: contact your doctor if you have jaw pain, toothache, loose teeth, or gum sores.
• Reversible Posterior Leukoencephalopathy Syndrome (RPLS): a rare brain condition; seek urgent care for seizures, severe headache, confusion, or vision changes.
• Hepatic encephalopathy in liver cancer patients: contact your doctor promptly for new confusion, drowsiness, or altered behaviour.

Other General Warnings

• You have unusual or heavy bleeding, as Cabozantinib can cause serious bleeding.
• You develop persistent or severe abdominal pain, which may be a sign of a hole (perforation) or abnormal connection (fistula) in the stomach or intestine.
• You experience sudden chest pain, breathlessness, or swelling or pain in a limb, as these may signal a serious blood clot.
• Your blood pressure is high or difficult to control; it should be well-controlled before starting and monitored throughout treatment.
• You develop jaw pain, tooth pain, loose teeth, or gum sores, or you need any dental procedure, as Cabozantinib can cause jaw bone damage (osteonecrosis); a dental exam is advised before starting.
• You are planning any surgery, including dental surgery, treatment should be stopped at least 4 weeks beforehand and restarted only once your doctor confirms the wound has healed adequately.
• You develop seizures, severe headache, vision changes, or confusion, as these may be signs of a rare brain condition (RPLS).
• You have liver cancer and notice new confusion, drowsiness, or personality changes, as this may be hepatic encephalopathy.
• You feel unusually tired, gain weight, or feel cold often, as this medicine can affect thyroid function. Thyroid function will be checked before and during treatment.
• You have heart problems or an abnormal heart rhythm, as your doctor may need to monitor your heart rhythm and blood electrolyte levels.
• You have liver problems; your doctor may adjust your dose in moderate liver impairment, and Cabozantinib is not recommended in severe liver impairment. Liver function tests will be done before and during treatment.
• You have kidney problems; the medicine is used with caution in mild-to-moderate kidney impairment and is not recommended in severe kidney impairment.
• You are a man or woman planning to have children, as Cabozantinib may impair fertility in both sexes; ask about fertility preservation before starting.
• Always take Cabozantinib on an empty stomach, at least 1 hour before or 2 hours after food, as food can affect how much of the medicine your body absorbs.
• Never substitute the tablets with cabozantinib capsules; the two are not interchangeable.
• Tell your doctor immediately about any unusual bleeding, such as coughing up blood, vomiting blood, or red or black tarry stools, as this medicine can cause serious bleeding.
• Report painful redness, swelling, or blisters on your palms or soles at the first sign, as early management of hand-foot syndrome can stop it from worsening.
• Have a dental check-up before starting, maintain good oral hygiene, and tell your dentist you are on this medicine, as it carries a risk of jawbone problems.
• Monitor your blood pressure regularly, as high blood pressure is very common on this medicine and may need treatment.
• Avoid grapefruit and St. John's Wort throughout your treatment.
• Both men and women should use effective contraception (including a barrier method) during treatment and for at least 4 months after the last dose.
• Stop Cabozantinib at least 4 weeks before any planned surgery or invasive dental procedure, but only under your doctor's instruction.
• Keep out of reach of children and pets.

How Does It Work?

Interactions with other medicines

• Some medicines can affect how Cabozantinib works. Tell your doctor about all medicines, supplements, vitamins, and herbal products you take.
• Strong CYP3A4 inhibitors (such as ketoconazole, itraconazole, clarithromycin, erythromycin, and ritonavir) can increase Cabozantinib levels and the risk of side effects. Your doctor may adjust the dose.
• Strong CYP3A4 inducers (such as rifampicin, phenytoin, carbamazepine, phenobarbital, and St. John's Wort) can reduce its effectiveness and should generally be avoided.
• Cabozantinib may affect some other medicines, such as digoxin, dabigatran, colchicine, and warfarin. Your doctor may need to monitor you more closely.
• Oral contraceptive pills may be less reliable during treatment. Use an additional barrier method, such as condoms.
• Antacids, PPIs, and H2-blockers generally do not significantly affect Cabozantinib and can usually be taken without changing the dose.
• Note: Always tell your doctor about all prescription medicines, over-the-counter medicines, vitamins, supplements, and herbal products you take.

Interactions with food items

Overdose

Missed a Dose