Cabozantinib Side Effects: A Patient’s Guide to Management & Care

Summary

 

Cabozantinib, sold as Cabometyx and Cometriq, is a powerful targeted therapy used to treat several advanced cancers, including kidney (renal cell carcinoma), liver (hepatocellular carcinoma), and a type of thyroid cancer (medullary thyroid cancer). It works by blocking multiple pathways that fuel tumor growth and blood supply. This guide explains how cabozantinib side effects, it works, its uses, dosage, and cost.

Introduction to Cabozantinib: A Targeted Cancer Therapy

In the complex landscape of cancer treatment, the advent of targeted therapies has revolutionized patient outcomes by offering more precise and effective solutions. At the forefront of this evolution is cabozantinib, a small molecule kinase inhibitor designed to specifically block the growth and spread of cancer cells. Unlike traditional chemotherapy, which attacks all rapidly dividing cells, cabozantinib is a targeted therapy that zeros in on the molecular machinery that fuels tumor growth, making it a critical treatment option for a variety of advanced cancers.

 

Discovered and developed by Exelixis Inc., cabozantinib drug has a well-established history of FDA approvals, starting with its first in 2012 for medullary thyroid cancer. Since then, its use has expanded to include advanced kidney cancer (renal cell carcinoma) and liver cancer (hepatocellular carcinoma). 

Understanding the Mechanism of Action 

To truly appreciate the power of cabozantinib, it is essential to understand its mechanism of action. Cancer cells are notorious for their ability to hijack normal cellular processes to proliferate uncontrollably, form new blood vessels (angiogenesis) to feed themselves, and metastasize to other parts of the body. They accomplish this by sending out and receiving specific molecular signals, often mediated by proteins called tyrosine kinases.

 

Cabozantinib works as a multikinase inhibitor, meaning it blocks multiple tyrosine kinases simultaneously. Its primary targets include:

 

VEGFR (Vascular Endothelial Growth Factor Receptor): This pathway is a master regulator of angiogenesis. By inhibiting VEGFR, cabozantinib effectively cuts off the blood supply to the tumor, starving it of the oxygen and nutrients it needs to grow. This is why it is often referred to as a VEGFR inhibitor cabozantinib.

 

MET (Mesenchymal-Epithelial Transition Factor): The MET pathway is crucial for cell proliferation, survival, and mobility, playing a significant role in metastasis. Blocking MET helps to stop cancer cells from spreading to other organs, such as the kidney liver and lungs. This makes cabozantinib a met inhibitor.

 

RET (Rearranged during Transfection): This is a key driver of medullary thyroid cancer. Inhibiting the RET pathway is central to cabozantinib’s efficacy in treating this specific cancer type.

 

By simultaneously targeting these diverse pathways, cabozantinib provides a powerful, multi-pronged attack on the tumor, making it highly effective against a range of malignancies. This approach is what sets it apart as a true TKI cabozantinib and a modern oncology drug.

 

Approved Indications and Uses

The versatility of cabozantinib is demonstrated by its multiple FDA-approved indications. The specific cabozantinib indications determine which brand name—Cabometyx or Cometriq—is prescribed, as their formulations are not interchangeable.

 

Advanced Renal Cell Carcinoma (RCC)

Cabozantinib has a strong track record in treating advanced renal cell carcinoma (RCC), the most common type of kidney cancer. It is often used as a cabozantinib rcc second line treatment after patients have progressed on prior anti-angiogenic therapy. The drug’s ability to inhibit both VEGFR and MET is particularly effective in RCC, where these pathways are highly active. In a significant cabozantinib clinical trial known as the METEOR trial, the drug demonstrated superior progression-free survival compared to everolimus, solidifying its role in the treatment sequence. More recently, the FDA also approved the use of cabozantinib in combination with nivolumab (an immunotherapy drug) as a cabozantinib rcc first line treatment, further expanding its utility.

 

Hepatocellular Carcinoma (HCC)

Hepatocellular carcinoma (HCC), a type of liver cancer, is notoriously difficult to treat. Cabozantinib (as Cabometyx) is approved for patients with HCC who have been previously treated with sorafenib. The pivotal CELESTIAL phase 3 trial showed that cabozantinib celestial significantly improved overall survival and progression-free survival in this patient population, showcasing its effectiveness even in a post-sorafenib setting. The cabozantinib hcc phase 3 results were a major win for patients with this aggressive disease.

 

Medullary Thyroid Cancer (MTC)

Cabozantinib (as Cometriq) was initially approved for the treatment of progressive, metastatic, or unresectable medullary thyroid cancer. This specific indication is where the drug’s potent RET kinase inhibitory activity is most critical. For patients with MTC, which can be challenging to manage, Cometriq provides a vital tool to slow disease progression and improve patient outcomes.

 

Emerging Indications: Neuroendocrine Tumors (NETs)

The landscape of neuroendocrine tumors (NETs) and pancreatic neuroendocrine tumors (pNETs) is rapidly changing, and cabozantinib is at the forefront of this evolution. The recent CABINET trial, a major cabozantinib clinical trial, demonstrated a significant and clinically meaningful improvement in progression-free survival for patients with neuroendocrine tumors (both pancreatic and non-pancreatic) who had progressed on prior therapy. These findings have led to a supplemental New Drug Application (sNDA) to the FDA, and it is anticipated that cabozantinib will soon become a new standard of care for advanced neuroendocrine malignancies. This is a game-changer for a patient population with limited treatment options.

 

Dosage and Administration: A Practical Guide

Proper cabozantinib dosage and administration are crucial for maximizing its effectiveness and managing potential adverse effects.

 

Cabometyx vs. Cometriq: The Key Difference

It is a critical and non-negotiable point that Cometriq (cabozantinib capsules) and Cabometyx (cabozantinib tablets) are not interchangeable. The two formulations have different bioavailability, meaning the body absorbs them differently.

 

Feature	Cabometyx (Tablets)	Cometriq (Capsules)
Indications	RCC, HCC, Differentiated Thyroid Cancer	Medullary Thyroid Cancer
Formulation	Tablets (20 mg, 40 mg, 60 mg)	Capsules (20 mg, 80 mg)
Dose for MTC	Not used	140 mg daily
Dose for RCC/HCC	60 mg daily	Not used
Primary Target	Multi-target TKI for broader cancers	Specific TKI for RET-driven MTC
Patient Advice	Do not substitute one for the other.	Must follow prescribing information for the correct brand.

 

Recommended Dosing for Various Cancers

Renal Cell Carcinoma (RCC): The recommended cabozantinib daily dose is 60 mg, taken orally once a day. When used in combination with nivolumab, the recommended dosage is 40 mg once daily.

 

Hepatocellular Carcinoma (HCC): The recommended cabozantinib dose is 60 mg, taken orally once a day.

 

Medullary Thyroid Cancer (MTC): The recommended dose for Cometriq is 140 mg once a day. This dose is achieved by taking a combination of 80 mg and 20 mg capsules.

 

Important Administration Precautions

Empty Stomach: Both the cabozantinib capsule and cabozantinib tablet should be taken on an empty stomach, at least one hour before or two hours after a meal. This is critical for proper absorption of the cabozantinib oral medication.

 

Swallow Whole: The tablets and capsules must be swallowed whole. They should not be crushed, chewed, or opened, as this can alter the dosage and lead to an increased risk of side effects.

 

Missed Dose: If you miss a dose, do not take it if it is less than 12 hours before your next scheduled dose. Simply resume the regular schedule.

 

Grapefruit Interaction: Avoid grapefruit and grapefruit juice, as they can interfere with the metabolism of cabozantinib and increase the drug concentration in your body, potentially leading to more severe side effects.

 

Dosage Modifications and Adjustments

Your doctor may need to adjust your dose based on how well you tolerate the drug. Dose reductions (e.g., from 60 mg to 40 mg, or 40 mg to 20 mg) are a common way to manage side effects while continuing treatment. It is vital to communicate with your doctor about any side effects you experience.

 

Cabozantinib Side Effects and Adverse Effects

Like any powerful cancer drug, cabozantinib has a range of side effects and adverse effects. Understanding these is key to patient safety and quality of life.

 

Common Cabozantinib Side Effects

These are the most frequently reported side effects, affecting more than 10% of patients:

 

Gastrointestinal Issues: Diarrhea, nausea, vomiting, constipation, stomatitis (mouth sores), and abdominal pain.

 

Constitutional Symptoms: Fatigue, weight loss, and decreased appetite.

 

Skin and Hair Changes: Palmar-plantar erythrodysesthesia (hand-foot syndrome), rash, and hair color changes.

 

Cardiovascular: Hypertension (high blood pressure).

 

Biochemical Abnormalities: Elevated liver enzymes, low calcium, potassium, or magnesium levels.

 

Less Common but Serious Adverse Cabozantinib Side Effects

While less frequent, these cabozantinib adverse effects require immediate medical attention:

 

Hemorrhage: Severe bleeding events, including internal bleeding.

 

Fistulas and Perforations: Abnormal connections between organs (fistulas) or holes in the gastrointestinal tract (perforations).

 

Thrombotic Events: Blood clots in the veins (venous thromboembolism, e.g., pulmonary embolism) or arteries (arterial thromboembolism).

 

Hypertensive Crisis: A sudden, severe increase in blood pressure.

 

Osteonecrosis of the Jaw: A rare but serious condition involving the breakdown of jaw bone tissue.

 

Managing Cabozantinib Side Effects: Practical Advice for Patients

Communication is Key: Report all side effects to your healthcare team promptly. They can guide you on management strategies or suggest a dose adjustment.

 

Hydration: Diarrhea and vomiting can lead to dehydration. Stay well-hydrated by drinking plenty of fluids.

 

Skin Care: For hand-foot syndrome, apply thick moisturizers to your hands and feet daily. Avoid hot water and wear comfortable, well-fitting shoes.

 

Dietary Adjustments: Consider a bland diet to help with nausea and diarrhea. Avoid spicy, fatty, or acidic foods.

 

Pain Management: Over-the-counter pain relievers or prescription medication can help with joint and muscle pain.

 

Navigating the Price of Cabozantinib

The cost of cabozantinib can be a significant concern for patients. As a specialty oncology drug, its price reflects the extensive research and development required to bring it to market.

Cabozanix 80 MG Price Per 30 Tablets: $925.00

Cabozanix 60 MG Price Per 30 Tablets : $890.00

Cabozanix 20 MG Price Per 30 Tablets:  $810.00

Caboxen 80 MG Price Per 30 Tablets: $225.00

Caboxen 20 MG Price Per 30 Tablets: $200.00

Cabanib 60 MG Price Per 30 Tablets:

Cabanib 20 MG Price Per 30 Tablets: $200.00

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Cabozantinib Cost and Price in the USA

Without insurance, the cabozantinib price can be extremely high. For example, a 30-day supply of Cabometyx can range from $26,000 to over $27,000 in U.S. retail pharmacies. The cabozantinib 60 mg price is typically higher than lower dosages like cabozantinib 40 mg price or cabozantinib 20 mg.

 

Financial Assistance and Patient Support Programs

Recognizing the financial burden, the manufacturer, Exelixis, offers the Exelixis Access Services (EASE) program. This program provides various forms of support, including:

 

• Copay assistance for commercially insured patients, potentially reducing the out-of-pocket cost to as low as $0.
• Free 30-day trials for new, eligible patients.
• Assistance with prior authorization and appeals to help patients navigate complex insurance paperwork.

 

Additionally, patients may explore patient assistance programs offered by non-profit organizations or consider purchasing through certified international pharmacies, which can sometimes offer lower prices, though this requires careful verification of their credentials.

 

Cabozantinib in Clinical Trials and Future Directions

The journey of cabozantinib is far from over. Ongoing research and cabozantinib clinical trials are exploring its potential in a wider range of malignancies.

 

Recent Breakthroughs in Neuroendocrine Tumors

As highlighted earlier, the CABINET trial’s success in pancreatic neuroendocrine and other neuroendocrine tumors is a landmark event. This study demonstrated that cabozantinib significantly improved progression-free survival compared to placebo, a crucial finding for a difficult-to-treat cancer. This is a powerful testament to the drug’s effectiveness and its potential to become a new standard of care.

 

Ongoing Research in Other Cancer Types

Researchers are actively investigating cabozantinib’s potential in other cancers, including lung cancer (specifically non-small cell lung cancer or NSCLC), prostate cancer, and bladder cancer. The drug’s ability to inhibit multiple pathways makes it a strong candidate for combination therapies, such as with immunotherapy drugs. This is an exciting area of research that could lead to even more effective treatments in the future.

 

Patient Reviews and Success Stories

The true measure of a drug’s impact lies in the stories of the patients it helps. A look at cabozantinib patient reviews and cabozantinib success stories reveals a mix of challenges and triumphs. Many patients report significant tumor shrinkage or disease stabilization, allowing them to lead more active and longer lives. While cabozantinib side effects are a common theme, many patients learn to manage them through dosage adjustments and supportive care, ultimately finding the benefits of the drug far outweigh the drawbacks. The cabozantinib success rate can vary, but for many, it has offered a renewed sense of hope and a high quality of life.

 

Alternatives to Cabozantinib Targeted Therapy

For patients with RCC, HCC, or other cancers, cabozantinib is one of several available options. Other targeted therapies and immunotherapies are also used, and the choice of treatment depends on the specific cancer type, stage, patient health, and previous treatments. Alternatives include:

 

Sunitinib (Sutent): A TKI used for RCC and pNETs.

 

Pazopanib (Votrient): Another TKI approved for RCC.

 

Pembrolizumab (Keytruda) and Nivolumab (Opdivo): Immunotherapy drugs that are now often used as first-line treatments for RCC, sometimes in combination with TKIs.

 

The decision to use cabozantinib vs sunitinib or cabozantinib vs pazopanib is a complex one that your oncologist will make based on clinical data and individual patient factors.

 

Conclusion: The Transformative Role of a Targeted Drug

Cabozantinib stands as a powerful example of the progress made in modern oncology. By specifically targeting the molecular pathways that drive tumor growth and metastasis, it offers a sophisticated and effective treatment for a range of advanced cancers, from kidney liver and thyroid cancer to neuroendocrine tumors. Its diverse applications, supported by strong clinical evidence, make it a crucial tool for oncologists worldwide. While the management of its side effects requires vigilance and collaboration between patient and physician, the cabozantinib effectiveness and ability to improve patient outcomes is undeniable. As research continues to unfold, this cabozantinib targeted therapy is poised to extend its reach, offering hope to even more patients in the future.

 

Frequently Asked Questions (FAQs)

1. Is Cabozantinib a type of chemotherapy?

No, cabozantinib is not chemotherapy. It is a targeted therapy and a type of small molecule kinase inhibitor. Unlike traditional chemotherapy, which attacks all rapidly dividing cells, cabozantinib works by specifically blocking certain proteins (tyrosine kinases) that are involved in the growth, spread, and blood supply of cancer cells. This targeted approach generally leads to a different set of cabozantinib side effects than conventional chemotherapy.

 

2. How long does it take for Cabozantinib to start working?

The effects of cabozantinib can be seen relatively quickly, but the time to a measurable response varies by patient and cancer type. In cabozantinib clinical trials, some patients showed tumor shrinkage within a few weeks, while others saw disease stabilization that lasted for many months or years. Your doctor will monitor your progress with regular scans and blood tests to determine the drug’s effectiveness in your case.

 

3. Can I take Cabozantinib with food?

No. It is crucial to take cabozantinib on an empty stomach. You should not eat anything for at least one hour before or two hours after taking your dose. This is because food can interfere with the absorption of the drug, making it less effective.

 

4. Is Cabozantinib approved for prostate cancer?

Cabozantinib is not currently FDA-approved for prostate cancer. However, it is being studied in cabozantinib clinical trials for prostate cancer and other malignancies. These studies are investigating its potential to treat various types of tumors by targeting the specific molecular pathways that may be involved.

 

5. What is the difference between Cometriq and Cabometyx?

Cometriq and Cabometyx are both brand names for cabozantinib, but they are different formulations (capsules and tablets, respectively) and are used for different indications. Cometriq is specifically for medullary thyroid cancer, while Cabometyx is for renal cell carcinoma and hepatocellular carcinoma. They are not interchangeable due to differences in how the body absorbs them, and substituting one for the other could lead to incorrect dosing and a higher risk of adverse effects.