When taking cabozantinib, attention should be paid to fasting or with meals, and the principles of missed doses and discontinuation of medication should be strictly followed. High fat meals can increase drug absorption. If missed, double the dosage should not be taken. Discontinuation of medication should be adjusted according to the severity of adverse reactions. The following items provide detailed medication guidelines.

1. Medication time and dietary requirements

When cabozantinib capsules (Cometriq) are taken with high-fat meals, the peak concentration and AUC increase by 41% and 57%, respectively. It is recommended to maintain dietary consistency. Tablets (Cabometyx) do not explicitly require fasting, but foods known to affect CYP3A4 (such as grapefruit) should be avoided.

Principles for handling missed doses

If one dose is missed, it can be taken immediately within 12 hours; If it exceeds 12 hours, skip the dose and take the next dose according to the original plan. Do not take double doses to avoid cumulative toxicity. If you have missed taking medication continuously for more than 3 days, you need to contact a doctor to evaluate the treatment plan.

3 Planned discontinuation guidelines

Medication should be stopped for at least 3 weeks before elective surgery, and recovery should be confirmed 2 weeks after wound healing after surgery. When combined with nivolumab, grade 2 liver toxicity occurs and medication should be suspended. After recovery, cabozantinib should be reduced by 20mg. Permanent discontinuation is only applicable for grade 4 adverse reactions or repeated grade 3 events.

4. Response to unplanned discontinuation of medication

If grade 3 diarrhea or hypertension occurs, medication should be temporarily suspended, and the symptoms should be reduced to grade 1 before recovery. Treatment for hand foot syndrome grade 2 or above should be interrupted, and the dose should be reduced by 20mg upon recovery. Sudden vomiting of blood, intestinal perforation, or hypertensive crisis require permanent discontinuation of medication and emergency treatment.

Differences in drug discontinuation among 5 special populations

Patients with liver dysfunction who experience elevated ALT/AST levels require earlier intervention, and those with moderate impairment have a maximum dose limit of 40mg/day. When combined immunotherapy is used, medication should be suspended and hormone replacement should be given immediately if the adrenal insufficiency is grade 2.