Due to the characteristics of cardiomyopathy, hepatotoxicity, and hepatic and renal metabolism, some patients are contraindicated or require extremely cautious use of cabozantinib. The following three groups of people have significantly increased medication risks and must be considered after professional evaluation.

1. Decreased left ventricular ejection fraction

1.1 Prohibition criteria: Patients with baseline LVEF below the lower limit of normal or known symptomatic heart failure are prohibited from using cabozantinib.

1.2 Situations that need to be paused: During the treatment period, if the LVEF decreases by more than 10% from baseline and the absolute value is less than 50%, medication should be paused. After recovery, decide whether to reduce the dosage and restart under the guidance of a doctor.

1.3 Monitoring requirements: Prior to treatment, a cardiac ultrasound examination must be performed, and follow-up examinations must be conducted one month after the start of treatment and every three months thereafter. When experiencing symptoms of difficulty breathing, palpitations, or edema, immediate cardiac function assessment is necessary.

2. Severe liver dysfunction

2.1 Prohibition criteria: Patients with severe liver function impairment are prohibited from using cabozantinib. The drug is mainly metabolized by the liver, and severe damage to liver function can significantly increase drug exposure and increase the risk of toxicity.

2.2 Pre medication evaluation: Monitor transaminase and bilirubin levels monthly before and during treatment. If the transaminase level rises to more than three times the normal upper limit or there are signs of liver damage, the medication should be temporarily or permanently discontinued.

3. Severe renal insufficiency

3.1 Use with caution: There is limited data on the use of cabozantinib in patients with severe renal insufficiency, and a careful decision should be made after weighing the pros and cons.

3.2 Monitoring suggestion: Regularly monitor renal function indicators during treatment. If there is a significant increase in creatinine or a decrease in urine output, adjust the dosage or suspend medication in a timely manner.

3.3 Alternative options: For patients with end-stage renal disease or dialysis, it is recommended to prioritize other treatment pathways to avoid potential cumulative toxicity.