+ -Text Size

Cabozantinib

(cab-oh-zant-uh-nib)

Trade/other name(s): Cometriq

Why would this drug be used?

This drug is used to treat advanced medullary thyroid cancer. It is also being studied for use against a number of other cancers.

How does this drug work?

Cabozantinib is a type of targeted therapy known as a tyrosine kinase inhibitor. Tyrosine kinases are proteins at the surface of a cell that signal the cell’s control center to grow and divide or help form new blood vessels (angiogenesis) to feed the tumor. By blocking these proteins, cabozantinib can help stop the growth of cancer cells.

Before taking this medicine

Tell your doctor…

  • If you are allergic to anything, including medicines, dyes, additives, or foods.
  • If you have high blood pressure. Cabozantinib may raise blood pressure. Your doctor will want to monitor this closely during treatment (see “Precautions” section).
  • If you have any type of liver disease (including hepatitis). This drug is cleared from the body mainly by the liver. Reduced liver function might result in more drug than expected staying in the body, which could lead to unwanted side effects. Cabozantinib should not be used in people whose liver is not functioning well.
  • If you have a recent history of bleeding or coughing up blood, if you have an open wound, or if you are going to have surgery or a dental procedure. This drug can increase your risk of serious bleeding (see “Precautions” section).
  • If you are being treated for seizures. Some drugs used to prevent seizures can interact with cabozantinib (see “Interactions”).
  • If you have diarrhea. This drug can cause diarrhea or make it worse. You may be given medicines to help prevent this (see “Precautions”).
  • If you have any other medical conditions such as heart disease, kidney disease, diabetes, gout, or infections. These conditions may require more careful monitoring by your doctor.
  • If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. This drug can cause problems with the fetus if taken at the time of conception or during pregnancy (see “Precautions”).
  • If you are breast-feeding. While no studies have been done, this drug may pass into breast milk and affect the baby. Breast-feeding is not recommended during treatment with this drug.
  • If you think you might want to have children in the future. This drug may affect fertility. Talk with your doctor about the possible risk with this drug and the options that may preserve your ability to have children.
  • About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

Interactions with other drugs

Cabozantinib can interact with a number of drugs and supplements, so it is important to not start or stop taking any of medicines while on cabozantinib without talking with your doctor(s) about all of the medicines you take, including cabozantinib.

Some drugs and supplements can lower the levels of cabozantinib in the blood, which might make it less effective:

  • Anti-seizure drugs, such as carbamazepine (Tegretol), phenobarbital (Solfoton), and phenytoin (Dilantin)
  • Drugs to treat tuberculosis (TB), such as rifampin (Rifadin, Rimactane; also in Rifamate and Rifater), rifabutin (Mycobutin), and rifapentin (Prifin)
  • The steroid drug dexamethasone (Decadron)
  • St. John’s wort (herbal dietary supplement)

Some drugs and supplements could cause cabozantinib to build up in your blood, which might worsen side effects and other problems:

  • Some antibiotics, such as erythromycin, clarithromycin (Biaxin), telithromycin (Ketek), and similar drugs
  • Some anti-fungal medicines, such as ketoconazole (Nizoral), itraconazole (Sporanox), posaconazole (Noxafil), and voriconazole (Vfend)
  • Some anti-depressant drugs, such as nefazodone (Serzone)
  • Some anti-HIV drugs, such as indinavir (Crixivan), ritonavir (Kaletra), nelfinavir (Viracept), atazanavir (Reyataz), saquinavir (Invirase), and others

These drugs should be avoided while taking cabozantinib if possible. If you need to take one of them, your dose of cabozantinib will need to be adjusted.

Cabozantinib might also affect the levels of some other medicines in your body.

Drugs or supplements that interfere with blood clotting may raise the risk of bleeding during treatment with cabozantinib. These include:

  • Vitamin E
  • Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and many others
  • Warfarin (Coumadin), dabigatran (Pradaxa), or other blood thinners, including any type of heparin injections
  • Clopidogrel (Plavix)

Note that many cold, flu, fever, and headache remedies contain aspirin or ibuprofen. Ask your doctor or pharmacist if you aren’t sure what’s in the medicines you take.

Check with your doctor, nurse, or pharmacist about any other medicines, herbs, and supplements you are taking, and whether alcohol can cause problems with this medicine.

Interactions with foods

This drug should not be taken with food (see next section).

Grapefruit, grapefruit juice, or grapefruit extract may affect the amount of cabozantinib in your body. You should avoid grapefruit products while taking this drug. Check with your doctor, nurse, or pharmacist about whether any other specific foods may be a problem.

Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

Cabozantinib is taken once daily as capsules. Do not eat for at least 2 hours before and at least 1 hour after taking this drug.

Swallow the capsules whole with a full glass (at least 8 ounces) of water. Do not open, chew, or crush the capsules.

The recommended starting dose is 140 milligrams (mg) once a day (one 80-mg capsule and three 20-mg capsules). The daily dose may need to be delayed and/or adjusted if you have side effects.

Take this drug exactly as directed by your doctor. If you do not understand the instructions, ask your doctor or nurse to explain them to you. Keep the medicine in a tightly closed container away from heat and moisture and out of the reach of children and pets.

Precautions

Cabozantinib may cause a number of side effects, some of which can be serious or even life threatening. Be sure to follow your doctor’s instructions for taking this drug and report any new side effects right away.

This drug may interact with a number of other drugs or supplements in the body – see “Interactions” above. Be sure your doctor is aware of all drugs and supplements you are taking. Do not start or stop taking any drug without talking to your doctor about all the drugs you are taking.

In rare cases, this drug can cause a hole (perforation) in the intestines or an abnormal connection (fistula) between parts of the body that are not normally connected, such as between the trachea (windpipe) and esophagus or between different parts of the intestines. Tell your doctor or nurse right away if you have severe pain in your stomach area, nausea, vomiting, or fever, or if you begin coughing, choking, or gagging, especially when eating or drinking.

This drug may increase your risk of bleeding. Speak with your doctor before taking any drugs or supplements that might affect your body’s ability to stop bleeding, such as aspirin or aspirin-containing medicines, warfarin (Coumadin), or vitamin E. Tell your doctor right away if you cough up or vomit blood, have unusual bruising, or bleeding such as nosebleeds, heavy menstrual bleeding, bleeding gums when you brush your teeth, or black, tarry stools.

This drug may raise your risk of problems due to blood clots, including heart attacks, strokes, transient ischemic attacks (“mini-strokes”), blood clots in leg veins (deep vein thrombosis), and blood clots in the lung (pulmonary embolism). Call your doctor right away if you have chest pain, shortness of breath, sudden sweating, lightheadedness, vision changes, numbness, weakness, trouble speaking or moving, severe headache, or swelling, pain, redness, or warmth in an arm or leg.

This drug can affect your body’s ability to heal wounds. It should not be used within 4 weeks before any planned surgery (including dental procedures) and should not be started again until the surgical wound is adequately healed.

Cabozantinib may cause high blood pressure or make it worse. Tell your doctor if you have ever had high blood pressure or are taking medicines for it. Your blood pressure should be checked regularly during treatment. If your blood pressure goes up, you may need to take medicine to help control it. Your doctor may need to adjust your dose or delay treatment with this drug if you have high blood pressure than can’t be controlled. If the high blood pressure is severe enough, you may need to stop taking this drug altogether. Tell your doctor right away if you notice any possible symptoms of high blood pressure, including a severe headache, chest pain, or feeling dizzy or light-headed.

In rare cases, this drug can damage the bones in the jaw, a condition called osteonecrosis of the jaw (ONJ). Your doctor should examine your mouth carefully before you start taking this drug. Talk with your dentist about the best ways to prevent problems while on this drug. While you are getting treatment, check with your doctor before having any dental procedures done. Tell your doctor if you notice loose teeth, swollen gums, or pain or numbness in your jaw.

This drug can cause a condition known as hand-foot syndrome, in which a person may have pain, numbness, tingling, redness, or swelling in the hands or feet. When severe, this can cause peeling, blistering, or open sores on the skin in these areas. Let your doctor know right away if you notice any of these symptoms.

This drug may damage your kidneys, which can cause protein in the urine (proteinuria). Your urine will be checked for this before and during treatment. If the amount of protein is high, your doctor may delay your treatment until your kidneys are working better and less protein is found in your urine. Treatment may need to be stopped altogether if there are signs of serious kidney damage. Tell your doctor right away if you notice any possible symptoms of kidney damage, including swelling in your hands, legs, or feet.

In rare cases, this drug may affect the brain, causing what is known as reversible posterior leukoencephalopathy syndrome (RPLS). Symptoms of RPLS might include seizures, headache, trouble thinking, confusion, changes in vision, or other problems. Tell your doctor right away if you notice any of these symptoms.

This drug may cause diarrhea. If left unchecked, this could lead to dehydration and chemical imbalances in the body. Your doctor may prescribe medicine to help prevent or control this side effect. Let your doctor or nurse know if you develop diarrhea while on this drug.

Your doctor will likely test your blood throughout your treatment, looking for effects of the drug on blood counts or on blood chemistry levels. Based on the test results, you may be given medicines to help treat any effects. Your doctor may also need to reduce or delay your next dose of this drug, or even stop it completely. Be sure to keep all your appointments for lab tests and doctor visits.

Avoid pregnancy while taking this drug. It may harm the fetus. Women who could become pregnant and their partners should use effective birth control during treatment with this drug and for at least 4 months afterward. Check with your doctor about what kinds of birth control can be used with this medicine. Tell your doctor right away if you (or your female partner) become pregnant while taking this drug.

Possible side effects

You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them.

Common

  • Diarrhea*
  • Mouth sores or pain
  • Hand-foot syndrome (redness and pain in the palms of the hands and the soles of the feet)*
  • Weight loss
  • Loss of appetite
  • Nausea
  • Feeling tired
  • Changes in how things taste
  • Graying or loss of hair color
  • High blood pressure*
  • Constipation
  • Pain in the abdomen (belly)
  • Vomiting
  • Feeling weak
  • Voice changes
  • Abnormal blood tests suggesting drug may be affecting the liver, blood mineral levels, or blood cell counts (Your doctor will discuss the importance of these findings, if any.)

Less common

  • Skin rash or redness
  • Dry skin
  • Hair loss
  • Headache
  • Joint pain
  • Feeling dizzy
  • Trouble swallowing
  • Muscle spasms
  • Upset stomach
  • Hemorrhoids
  • Anxiety
  • Pain, numbness, or tingling in the hands or feet
  • Dehydration
  • Low blood pressure

Rare

  • Severe bleeding*
  • Hole (perforation) or abnormal connection (fistula) in the stomach or intestines*
  • Problems due to blood clots, including heart attack, stroke, transient ischemic attack (mini-stroke), or clots in the legs or lungs*
  • Protein in the urine, which can be a sign of kidney damage*
  • Slow healing of a wound or surgical incision (or re-opening of one that is healing)*
  • Changes in the brain that can cause headache, confusion, seizures, or blindness*
  • Damage to the jaw bone*
  • Death due to bleeding, infection, fistulas, or other causes

*See the “Precautions” section for more detailed information.

There are other side effects not listed above that can also occur in some patients. Tell your doctor or nurse if you develop these or any other problems.

FDA approval

Yes – first approved in 2012.

Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for talking with your doctor, who is familiar with your medical needs.


Last Medical Review: 12/05/2012
Last Revised: 12/05/2012