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.