Cabozantinib is an oral multi-target tyrosine kinase inhibitor

1、 Indications

Cabozantinib is a multi-target tyrosine kinase inhibitor suitable for:

1. Renal cell carcinoma (RCC): treatment for patients with advanced renal cell carcinoma; Or combined with nivolumab as first-line treatment for advanced RCC

2. Hepatocellular carcinoma (HCC): Treatment for hepatocellular carcinoma patients who have previously received sorafenib therapy

3. Differentiated thyroid cancer (DTC): Treatment for locally advanced or metastatic DTC patients aged 12 years and above who are refractory or unsuitable for radioactive iodine therapy, and who have previously undergone VEGFR targeted therapy and have progressed

4. Neuroendocrine tumors (NETs): Treatment for unresectable locally advanced or metastatic pancreatic (pNET) or extrapancreatic (epNET) highly differentiated neuroendocrine tumors aged 12 years and older who have previously received treatment

2、 Usage and dosage

Standard dose: 60mg orally once daily (for adults and adolescents weighing ≥ 40kg); Adjust the duration of treatment with nivolumab monotherapy to 40mg once daily

Special dose: 40mg once daily for adolescents weighing less than 40kg; Patients with moderate liver injury need to reduce their dosage

Medication requirements: Take on an empty stomach (1 hour before or 2 hours after meals), swallow the whole tablet and do not crush/chew it

Dose adjustment: Depending on the severity of adverse reactions, the dosage can be gradually reduced to 40mg or 20mg once daily. Severe adverse reactions require permanent discontinuation of the medication

Pre - and post-operative management: Stop medication 3 weeks before surgery, and resume medication at least 2 weeks after surgery and wound healing

3、 Side effects and precautions

Common adverse reactions (≥ 20%):

Single drug treatment: diarrhea, fatigue, skin reactions on hands and feet, decreased appetite, hypertension, nausea, vomiting, weight loss

Combination therapy: diarrhea, fatigue, hepatotoxicity, stomatitis, rash, hypertension, hypothyroidism, musculoskeletal pain

Serious risk warning:

Bleeding risk: May cause fatal bleeding, patients with recent bleeding history should not use it

Perforation/fistula: Monitor gastrointestinal symptoms, grade 4 fistula or perforation requires permanent discontinuation of medication

Thrombotic event: myocardial infarction or severe arteriovenous thrombosis requiring discontinuation of medication

Hypertension crisis: Regularly monitor blood pressure during treatment, adjust dosage if not well controlled

Wound healing disorders: medication should be temporarily suspended before and after elective surgery

Hepatotoxicity: Liver dysfunction is more common when combined with nivolumab and requires regular monitoring

Jaw necrosis: Oral examination is required before treatment, and treatment should be interrupted if jaw pain occurs

Embryotoxicity: Pregnant women should avoid using it, and patients of childbearing age should take effective contraceptive measures

4、 Medication for special populations

Pregnant women: May cause fetal damage, contraception is required during medication and within 4 months of discontinuation

Breastfeeding period: Breastfeeding is prohibited during the treatment period and within 4 weeks of discontinuation of medication

Children: Adolescents aged 12 and above need to be monitored for bone growth

Liver injury: Moderate liver injury should be reduced, and patients with severe liver injury should avoid using it

Cabozantinibinformation