cabozantinib: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
cabozantinib: clinical details
Prescribing considerations
- Confirm the licensed indication and formulation; capsules and tablets are not interchangeable.
- Treatment should be initiated and supervised by a clinician experienced in anticancer therapy.
- Assess bleeding, thromboembolic, gastrointestinal perforation or fistula, cardiovascular, aneurysm and wound-healing risks.
- Review planned surgery and invasive dental procedures before treatment.
- When combined with nivolumab, consult its product information and monitor closely for overlapping toxicity.
Contraindications and cautions
- Hypersensitivity to cabozantinib or a listed excipient.
- Do not administer to patients who have, or are at significant risk of, severe haemorrhage.
- Not recommended in severe renal impairment or severe hepatic impairment because adequate evidence is lacking.
Monitoring
- Blood pressure before treatment and early and regularly afterwards
- Full blood count, including platelets
- Liver function and clinical features of hepatic encephalopathy where relevant
- Renal function and urine protein
- Electrolytes, including calcium, potassium and magnesium
- Thyroid function at baseline and periodically
- Skin, gastrointestinal, neurological, cardiovascular and wound-healing toxicity
- Oral health and symptoms of osteonecrosis of the jaw
- ECG where QT-risk factors are present
Clinical pharmacology
Cabozantinib is an oral multikinase inhibitor targeting MET, VEGF receptors, RET, AXL and other kinases involved in angiogenesis, tumour progression and resistance. It is highly protein-bound, metabolised predominantly through CYP3A4 and eliminated mainly through the hepatobiliary route.
Formulation and product differences
- COMETRIQ is supplied as hard capsules and is licensed for medullary thyroid carcinoma.
- Cabozantinib Ipsen is supplied as film-coated tablets and has separate licensed indications.
- Tablet and capsule formulations are not bioequivalent and must not be substituted for one another.
- Cabozantinib Ipsen tablets contain lactose; capsule excipients differ.
cabozantinib preparations and strengths
Capsule
Route: Oral
Strengths: 80 mg
Tablet
Route: Oral
Strengths: 20 mg, 40 mg, 60 mg
cabozantinib interactions
Check prescribed, pharmacy-bought and herbal products with the oncology pharmacist because cabozantinib has clinically important interactions.
Strong CYP3A4 inhibitors, including clarithromycin, itraconazole and ritonavir
May increase cabozantinib exposure and toxicity; use requires specialist review.
Strong CYP3A4 inducers, including rifampicin, carbamazepine, phenytoin and phenobarbital
May substantially reduce cabozantinib exposure; chronic combined use should be avoided.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.