Cabozantinib is contraindicated for patients with severe liver injury and active bleeding, as its use may pose a fatal risk. The following items provide specific precautions and alternative suggestions for taboo populations.

1. Taboos for patients with severe liver injury

Cabozantinib is contraindicated in patients with severe liver dysfunction (Child Pugh C grade). Patients with mild to moderate liver function impairment need to adjust the dosage: capsules are limited to 80mg per day, and tablets are reduced to 40mg or 20mg according to indications. ALT/AST should be monitored regularly during medication, and if symptoms of liver toxicity occur, the medication should be stopped immediately.

2 contraindications for patients with active bleeding

Patients with a recent history of severe bleeding such as hemoptysis, vomiting blood, and black stool are prohibited from using it. Medication should be stopped for 3 weeks before surgery, and recovery can only be achieved 2 weeks after confirming wound healing after surgery. If bleeding of grade 3 or above occurs during treatment, the medication should be permanently stopped and the bleeding source should be urgently treated.

3 other absolutely taboo groups

Pregnant women are prohibited from using contraception (due to embryotoxicity), and women of childbearing age should use contraception for 4 months after the last dose. Breastfeeding is prohibited for lactating women during treatment and within 4 months of discontinuation of medication. People who are allergic to cabozantinib are prohibited from using it, and if an allergic reaction occurs, the medication must be permanently discontinued.

4 Relative taboos and risk warnings

Individuals with severe renal insufficiency lack safety data and require careful evaluation. When combined with nivolumab, the risk of liver toxicity doubles, and ALT/AST>10 times ULN requires permanent discontinuation of the drug. Individuals with uncontrolled hypertension, history of intestinal perforation, or non healing wounds require individualized assessment.