Indications for Cabozantinib

– Used to treat advanced renal cell carcinoma (RCC).
– Treats hepatocellular carcinoma (HCC) in patients previously treated with sorafenib.

Pharmacological Action

– Inhibits tyrosine kinase activity of several enzymes (MET, VEGFR-1, -2, -3, AXL, RET, and more), affecting cellular processes like oncogenesis and tumor microenvironment maintenance.

 Dosage Recommendations

 For Renal Cell Carcinoma

– Suggested dose is 60 mg once daily, taken without food, until either disease progression or unacceptable side effects occur.

 For Hepatocellular Carcinoma

– Also recommended at 60 mg once daily without food, continuing until disease progression or unacceptable toxicity is observed.

 Administration Guidelines

– Cease Cabozantinib at least 28 days before any surgery.
– Do not exchange Cabozantinib tablets for capsules.
– Take on an empty stomach, 1 hour before or 2 hours after meals.
– Tablets should be swallowed whole, not crushed.
– Skip missed dose if it’s close to the time of your next dose.
– Adjust dose for patients with liver issues or those on certain other medications.

### Drug Interactions

– Reduce dosage when taken with strong CYP3A4 inhibitors.
– Increase dosage if necessary when taken with strong CYP3A4 inducers.

Possible Side Effects

– May cause serious conditions such as bleeding, stomach or intestinal perforation, blood clots, stroke, heart attack, high blood pressure, diarrhea, hand-foot skin reaction, protein in urine, and potential kidney problems.

Pregnancy and Lactation

– Can harm a fetus, so should not be taken during pregnancy.
– Not recommended for breastfeeding women due to the potential for serious adverse reactions in the nursing baby.

 Precautions and Warnings

– Avoid in patients with recent bleeding events.
– Monitor for GI perforations or fistulas and discontinue if necessary.
– Stop treatment for severe thromboembolic events, uncontrollable hypertension, or hypertensive crisis.
– Interrupt treatment for severe diarrhea or palmar-plantar erythrodysesthesia until symptoms improve.
– Discontinue for proteinuria or nephrotic syndrome.
– Withhold before invasive dental procedures or for osteonecrosis of the jaw.
– Cease treatment for reversible posterior leukoencephalopathy syndrome (RPLS).
– Warn females of reproductive potential about the risk to a fetus and advise on effective contraception.

Use in Special Populations

– Not established for pediatric use.
– No significant differences in safety or effectiveness in geriatric patients compared to younger patients.
– No dosage adjustment needed for mild or moderate renal impairment.

Overdose Information

– Overdosage may lead to serious cognitive and physical impairments, though recovery details are often not documented.

Therapeutic Class

– Classified under cytotoxic chemotherapy.

Storage Conditions

– Keep at room temperature, between 20°C to 25°C.