Pronounced: ka" boe zan' ti nib
Facts about cabozantinib
Cabozantinib is a type of targeted therapy called a tyrosine kinase inhibitor. This means it works by targeting receptors present on the cancer cells. Cabozantinib targets several different receptors, which, in turn, blocks tumor growth and angiogenesis (the development of a blood supply to the tumor).
How to take cabozantinib
Cabozantinib comes in a capsule form in several dosage strengths. It is taken once a day on an empty stomach- you should not eat for 2 hours before or 1 hour after the dose. Swallow the capsules whole with a full glass (at least 8 ounces) of water; do not open capsules. Do not take a missed dose within 12 hours of the next scheduled dose, just skip that dose.
The blood levels of this medication can be affected by grapefruit, grapefruit juice, St. John’s wort and other medications. Be sure to tell your healthcare provider about all medications and supplements you take.
Side effects of cabozantinib
Below are some of the possible side effects and suggestions for dealing with them. Be sure to tell your oncology team if you are experiencing any of these problems.
High Blood Pressure
High blood pressure (hypertension) was seen in clinical trials. Patients should have their blood pressure checked regularly during therapy. Any hypertension should be treated appropriately. If hypertension cannot be controlled, the medication may be stopped.
Diarrhea can be severe and can cause dangerous dehydration. Be sure to report diarrhea to your healthcare team.
Your oncology team can recommend medications to relieve diarrhea. Also, try eating low-fiber, bland foods, such as white rice and boiled or baked chicken. Avoid raw fruits, vegetables, whole grain breads, cereals and seeds. Soluble fiber is found in some foods and absorbs fluid, which can help relieve diarrhea. Foods high in soluble fiber include: applesauce, bananas (ripe), canned fruit, orange sections, boiled potatoes, white rice and products made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Drink 8-10 glasses on non-alcoholic, un-caffeinated fluid a day to prevent dehydration. Read Low Fiber Diet for Diarrhea for more tips.
Mouth Ulcers (Sores)
Certain cancer treatments can cause sores or soreness in your mouth and/or throat. Notify your doctor or nurse if your mouth, tongue, inside of your cheek or throat becomes white, ulcerated or painful. Performing regular mouth care can help prevent or manage mouth sores. If mouth sores become painful, your doctor or nurse can recommend a pain reliever.
Read the mouth ulcer tip sheet for more information.
While on cancer treatment you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and conserve energy for more important activities. Exercise can help combat fatigue; a simple daily walk with a friend can help. Talk to your healthcare team and see OncoLink’s section on fatigue for helpful tips on dealing with this side effect.
Decrease in Appetite
Hand and Foot Syndrome (HFS)
HFS is a skin reaction that appears on the palms of the hands and/or the soles of the feet as a result of certain chemotherapy agents. It can start as a feeling of tingling or numbness in the palms and/or soles and progress to swelling, redness, peeling skin, and tenderness or pain. Notify your healthcare team right away if you notice any of these signs of HFS so they can make recommendations or dose changes to prevent it from getting worse. Learn more about HFS on OncoLink.
Nausea and/or Vomiting
Take anti-nausea medications as prescribed. If you continue to have nausea or vomiting, notify your doctor or nurse so they can help you manage this side effect. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy or acidic foods (lemons, tomatoes, oranges). Try antacids, (e.g. milk of magnesia, calcium tablets such as Tums), saltines, or ginger ale to lessen symptoms. Read the Nausea & Vomiting Tip Sheet for more suggestions.
Call your doctor or nurse if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.
Low White Blood Cell Count (Leukopenia or Neutropenia)
White blood cells (WBC) are important for fighting infection. While receiving treatment, your WBC count can drop, putting you at a higher risk of getting an infection. You should let your doctor or nurse know right away if you have a fever (temperature greater than 100.4¡), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.
Tips to preventing infection:
For more suggestions, read the Neutropenia Tip Sheet.
Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant or father a child while on this medication. Even if your menstrual cycle stops or you believe your sperm is affected, effective birth control is necessary during treatment and up to 4 months after stopping treatment.
Osteonecrosis of the Jaw
Osteonecrosis of the jaw (ONJ) is a rare side effect, however, it is important that you know about it and take steps to protect your dental health. The maxilla (upper jaw bone) and mandible (lower jaw bone) are normally covered by gum tissue. In the case of ONJ, this tissue is gone and the bone is exposed. Typical symptoms associated with ONJ are: pain, swelling or infection of the gums, loosening of the teeth, exposed bone (often at the site of a previous tooth extraction). Some patients may report numbness or tingling in the jaw or a "heavy" feeling jaw. ONJ may have no symptoms for weeks or months and may only be recognized by the presence of exposed bone. ONJ most often occurs soon after a dental procedure, but this is not required for ONJ to occur. Stop treatment with cabozanitib at least 3 weeks prior to any dental procedures.
Other Rare, But Emergent Side Effects
Cabozantinib can affect wound healing. Therefore, the manufacturer recommends stopping the drug at least 3 weeks before any surgical procedure and considering not restarting until there is adequate wound healing.
A neurologic complication, called reversible posterior leukoencephalopathy syndrome, has been reported. If you experience headache, seizure, confusion, blindness or other visual changes, inform your healthcare provider right away.
Cabozanitib can increase the risk of blood clots, stroke and heart attack. If you experience symptoms of these problems, you should contact your healthcare provider immediately or go to an emergency room. Symptoms can include: swelling, redness or pain in an extremity, chest pain or pressure, pain in your arm, back, neck or jaw, shortness of breath, numbness or weakness on one side of the body, trouble talking, confusion or mental status changes.
Some patients experienced bleeding or a tear in the intestinal wall. Signs of these problems include: unexpected bleeding, blood in the stool or black stools, cough up or vomit blood or vomit that looks like coffee grounds, fever, severe pain in the abdomen or new abdominal swelling. If you experience any of these, contact your healthcare provider immediately or go to the emergency room.
Other Side Effects
Other side effects include excess protein in the urine, for which your healthcare team will monitor you. Patients developed graying of their hair, loss of or change in hair color. Some patients experienced rash or dry skin.