Cabozantinib (Cabometyx)

What Is Cabozantinib?

Cabozantinib (pronounced [ka boe ZAN ti nib]) is also known by the brand names, Cabometyx or Cometriq. This medication is a type of chemotherapy.

Cabozantinib belongs to a class of drugs known as tyrosine kinase inhibitors (TKIs), which work by preventing an abnormal protein from triggering cancer cells to multiply. This aids in slowing or stopping the spread of cancer cells.

What Is Chemotherapy?

Chemotherapy is a cancer treatment in which certain drugs are used to kill cancerous cells. These drugs are usually cytotoxic chemical substances that are toxic to the cells, restrict their growth, prevent their division, and ultimately kill the cells.

Protection From Chemotherapy

Cabozantinib is considered to be a hazardous agent and normally, these pills are covered by a thin coating of material. If this coating is damaged, removed, opened, melted, or broken into pieces, the chemical inside the pill can cause damage to your skin if you touch it. Therefore, it is important to exercise appropriate precautions when receiving, handling, storing, administering, and disposing of this medication.

Wear gloves if touching this medication or avoid touching the pill entirely by using the cap of the bottle to scoop up the pill and put it directly into the mouth.

How Is Cabozantinib Used?

Cabozantinib has been approved by the Food and Drug Administration (FDA) for the treatment of hepatocellular (HCC), renal cell (RCC), and thyroid carcinomas. Currently, it is not available in generic form but available as the brands, Cabometyx or Cometriq.

Available Formulations

Cabozantinib is available in the form of tablets (Cabometyx) or capsules (Cometriq) that must be administered orally. Although both the tablets and capsules are the same drug, they are not interchangeable (you cannot substitute Cabometyx with Cometriq). They are available in four strengths: 20 mg, 40 mg, 60 mg, and 80 mg. The Cabometyx tablets are yellow film-coated, circular (20 mg), triangular (40 mg), or oval (60 mg) shaped with no score, and embossed with “XL” on one side.

Cabozantinib is typically dosed once a day, depending on the cancer type and severity. However, you should verify the correct dose and frequency with your provider.

Directions for Use

Take cabozantinib on an empty stomach at least 1 hour before or 2 hours after eating (if taken too close to a meal, it may not be absorbed to its full extent). Swallow the tablet/capsule whole; do not crush, chew, open, or allow it to be dissolved in your mouth. It is best to take this medication with a full glass (approximately 8 ounces) of water.

Missed Dose

If a dose is missed, take the dose as soon as possible, but if it is within 12 hours of the next dose, then skip the dose and continue with the next scheduled dose.

Storage

Store tablets and capsules in a cool, dry place at room temperature and ensure the bottle is tightly closed.

What To Avoid While Taking Cabozantinib

While on the cabozantinib therapy, you must follow some precautions. Always tell your physician about any medication you are already taking. Do not take any drug or medicine (even herbals or over-the-counter medications) without prior consent from your physician or pharmacist, as they may have some significant interactions with cabozantinib.

Avoid grapefruit, grapefruit juice, and any foods or supplements containing grapefruit or grapefruit juice throughout therapy, as they may also interact with this medication.

Pregnancy and Cabometyx

Pregnancy status must be checked prior to starting chemotherapy in women of childbearing age. Effective contraception must be used, and breastfeeding must be avoided during treatment and for 4 months after the last dose.

Side Effects

As with any other medication, you may encounter side effects while taking cabozantinib. A few things to keep in mind are:

• You may not have all the side effects listed below. Many people may experience little to no side effects.
• The severity of side effects may vary from person to person, so don’t compare your side effects with other people’s experiences.
• Most of the side effects will improve when therapy is discontinued.
• These side effects are easily manageable most of the time either by readjusting the dose of capecitabine or by using additional medications to treat the symptoms. Consult with your physician or pharmacist to explore the available options.
• Do not hide any symptoms; when you feel any discomfort, do not hesitate to tell your physician or pharmacist about it.

Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.

Some of the most common side effects of Capecitabine are:

Hair Loss

One of the most conspicuous side effects of chemotherapy is hair loss. This happens because most of the chemotherapy pills including capecitabine act on rapidly dividing cancerous cells as well as healthy cells of the body such as hair cells. However, the hair usually grows back once the chemotherapy is stopped. Changes in hair color can also occur.

Osteonecrosis of the Jaw (ONJ) 

Manifestations of ONJ may include jaw pain; osteomyelitis; osteitis; bone erosion; tooth or periodontal infection; mouth sores; choking, coughing, or gagging while drinking; toothache; jaw pain; gingival ulceration or erosion; persistent jaw pain or slow healing of the mouth or jaw after dental surgery.

Fluid/Electrolyte Imbalance

Fluid and electrolyte problems may occur, causing mood changes, confusion, muscle pain or weakness, heartbeat that does not feel normal, dizziness or passing out, fast heartbeat, increased thirst, feeling of being very tired or weak, feeling of not being hungry, inability to pass urine or change in the amount of urine produced, dry mouth, dry eyes, very bad upset stomach or vomiting, or in the worst case, seizures. High blood sugar is also possible. Symptoms of high blood sugar include confusion, sleepiness, increased thirst, hunger, more frequent urination, flushing, fast breathing, or breath that smells like fruit.

Thyroid Problems

Problems with the thyroid may occur, resulting in changes in weight, nervousness, excitability, restlessness, weakness, hair thinning, depression, neck swelling, inability to focus, trouble with heat or cold, menstrual changes, shakiness, or sweating.

Cardiac Complications

There is a risk that cabozantinib may cause high or low blood pressure. It may typically present as a very bad headache or dizziness, passing out, or a change in eyesight. Less commonly, however, it can potentially lead to blood clots, heart attacks, strokes, venous thromboembolism (VTE) or pulmonary embolism (PE) if left uncontrolled. Clots may present as chest pain or pressure, coughing up blood, shortness of breath, swelling, warmth, numbness, change of color or pain in a leg or arm, trouble speaking, or trouble swallowing. Typically, these side effects should be controlled with medications to treat high blood pressure.

Bleeding Complications

Bleeding problems may occur including bruising; black, tarry, or bloody stools; bleeding gums; blood in the urine; coughing up blood; cuts that take a long time to stop bleeding; feeling dizzy, very tired, or weak; nosebleeds; pain or swelling; throwing up blood; vomit that looks like coffee grounds; or a very bad headache.

Flu-Like Symptoms

Sweating, fever, chills, and a possible sore throat may occur during therapy and may subside on their own. 

Less common side effects can include:

• Constipation
• Nausea
• Vomiting
• Change in the ability to taste 
• Redness, swelling, sores, or pain in the mouth
• Loss of appetite
• Weight loss
• Extreme tiredness or weakness
• Pale and/or dry skin
• Muscle spasms
• Pain in joints, arms, or legs
• Voice changes or hoarseness
• Slow wound healing

Precautions

Unless approved by your physician, cabozantinib is generally not recommended in: 

• Patients who have an allergy to cabozantinib or any component of the formulation.
• Patients with severe kidney impairment. 
• Patients at high risk of GI perforations and fistulas or severe diarrhea. If any of these GI events occur, immediate discontinuation of cabozantinib is recommended.
• Patients at high risk of thrombotic events. Thrombotic events include heart attacks, ischemic stroke, venous thromboembolism (VTE), and pulmonary embolism (PE). If any of these thrombotic events occur, immediate discontinuation of cabozantinib is recommended.
• Patients with risk of high blood pressure.
  • Blood pressure should be monitored regularly.
  • Cabozantinib should be discontinued immediately if blood pressure is uncontrolled with therapy. 
• Patients with risk of osteonecrosis of the jaw (ONJ). Cabometyx therapy should be withheld for at least 28 days before any invasive dental procedures. 
• Patients with scheduled surgeries or procedures. Therapy may be suspended for at least 21 days before surgery or procedure and may be re-started after. Contact physician regarding any scheduled surgeries or procedures.

FAQs

Is cabozantinib a chemo agent?

Chemo drugs are those that are used in the management of various cancers. Cabozantinib kills the cancer cells. Thus, it is a chemo agent that is advised as a treatment option for various cancer patients. 

What is the best time to take cabozantinib?

Take cabozantinib on an empty stomach at least 1 hour before or 2 hours after eating.

Is cabozantinib available as a generic?

Currently, it is not available as a generic. It is only available as the brands Cabometyx (tablets) or Cometriq (capsules).

Can you touch cabozantinib?

Chemo drugs contain chemicals that are hazardous to health. Therefore, you should avoid touching it. Instead, wear gloves or pour the drug directly into the mouth using the cap of the drug bottle to avoid and minimize direct contact.