Cabozantinib (Cabometyx, Cometriq)

Cabozantinib at a glance

Cabozantinib blocks several proteins that help cancer cells grow and develop a blood supply. It is a tyrosine kinase inhibitor, often shortened to TKI. Verified brands are Cabometyx tablets and Cometriq capsules. Their doses and formulation instructions differ; switching is a specialist decision, not a milligram-for-milligram substitution.

Both are usually taken once daily on an empty stomach. Common problems include diarrhoea, tiredness, reduced appetite, sore hands or feet, mouth soreness and high blood pressure. Monitoring also checks liver function, urine protein, thyroid function and blood salts.

Cabozantinib can impair wound healing and increase bleeding risk. Tell your oncology team well before surgery, dental extraction or another invasive procedure is planned. Do not arrange a treatment break or restart date yourself.

Keep your medicine list, product name, prescribed dose and hospital contact details together. A written daily routine is especially useful if other medicines have different food instructions or if the team reduces your dose.

How cabozantinib works

Tyrosine kinases help transmit signals inside cells. Cabozantinib blocks several of these signalling proteins, including MET, VEGF receptors and AXL. This can interfere with cancer-cell survival and the development of blood vessels that supply a tumour.

The word “targeted” describes its mechanism. It does not mean healthy tissues are unaffected or that side effects are always mild. Effects on normal blood vessels help explain the need to monitor blood pressure, bleeding and wound healing.

Your team uses the tests relevant to your diagnosis to judge whether treatment is helping. These may include scans, blood tests and assessment of symptoms. Neither strong side effects nor an absence of side effects can tell you reliably whether the cancer is responding. Ask when the next response assessment is planned.

How your team decides whether it is suitable

Selection depends on the precise diagnosis, earlier treatments, laboratory findings, overall health and the particular formulation. There is no single tumour-marker test that applies to every cabozantinib prescription. The specialist should explain which tests guide your own treatment and why tablets or capsules have been selected.

Tell the team about high blood pressure, heart disease, blood clots, recent bleeding, liver or kidney problems, an aneurysm, bowel inflammation or obstruction, and any unhealed wound. Mention recent surgery or radiotherapy, difficulty swallowing, dental problems and medicines that affect blood clotting.

Liver impairment can change suitability or dosing, with differences between formulations and prescribing sources. Severe kidney impairment also requires particular assessment because experience is limited. These decisions cannot be made from symptoms alone. Your team needs the relevant blood results and medical history.

Before treatment starts

Checks generally include blood pressure, blood counts, liver and kidney function, blood salts including calcium, urine protein and thyroid tests. Blood pressure should be controlled before starting. Pregnancy testing is needed when applicable. Your team assesses dental health and any need for treatment before cabozantinib begins.

The current US information advises considering assessment of the heart's pumping function before treatment and periodically afterwards. This may involve an echocardiogram or another heart-function test. An ECG, which records electrical activity, and further electrolyte checks may be useful when heart-rhythm risks are present. Not everyone needs an identical testing schedule.

Bring all medicines and supplements to the review, including occasional antibiotics, antifungals and herbal products. Ask for a plan for diarrhoea, mouth care and hand–foot symptoms, and for the hospital's fever and urgent-contact instructions. Do not wait until symptoms are severe to find out whom to call.

Planned surgery and dental procedures

US labels require a pause of at least three weeks before elective surgery, including relevant invasive dental procedures. They require at least two weeks after major surgery and adequate wound healing before restarting. European information advises stopping at least 28 days before planned surgery or invasive dental work if possible, with restarting based on adequate healing.

Your surgeon, dentist and oncology team must agree the plan for the product you receive. A calendar interval alone does not establish that a wound is ready. Report an opening wound, discharge, increasing pain or slow healing. Urgent procedures need direct coordination rather than delaying necessary care to meet a routine timetable.

How to take cabozantinib

Tablets and capsules are different

Cabometyx tablets come in 20 mg, 40 mg and 60 mg strengths. A common adult starting schedule is 60 mg once daily when used alone, or 40 mg once daily with nivolumab. Reduced doses may be prescribed. These examples explain why prescriptions differ; they do not identify the right dose for you.

Cometriq capsules come in 20 mg and 80 mg strengths. The usual labelled starting dose is 140 mg once daily, made up of one 80 mg capsule and three 20 mg capsules. Lower doses may be needed. A larger milligram number does not mean the capsule regimen is interchangeable with a tablet regimen.

Check the brand, formulation, strength and number at every supply. If they differ from your written plan, ask the pharmacy before taking a dose. Do not use leftover tablets or capsules to assemble a new dose independently.

Food and swallowing

For either product, do not eat for at least two hours before the dose and at least one hour afterwards. Take it with water at about the same time each day. For example, an 8 am dose means no food after 6 am and breakfast no earlier than 9 am.

Swallow the medicine whole. Do not crush, chew or split Cabometyx tablets, and do not open Cometriq capsules. If swallowing becomes difficult or a feeding tube is needed, contact the team for a specific plan; do not improvise a mixture. Avoid grapefruit and grapefruit-containing drinks or foods throughout treatment.

Missed doses and vomiting

If the next dose is less than 12 hours away, skip the missed dose. If more than 12 hours remain, take it while keeping the fasting window. At exactly 12 hours, follow your supplied leaflet or check with the pharmacist because label wording differs. Never double a dose.

If you vomit after taking cabozantinib, do not take an additional dose. Take the next scheduled dose as directed and report repeated vomiting or difficulty keeping fluids down.

If you accidentally take too much, contact your treating team or emergency service promptly and take the packaging with you.

Storage and treatment changes

Keep the medicine in its original packaging, away from children, heat and moisture. US labels specify controlled room temperature at 20–25°C (68–77°F), with permitted brief excursions. Follow the supplied product's storage instructions, especially during travel or hot weather. Return unused medicine to the hospital or pharmacy.

The team may pause treatment, lower the dose or stop it because of side effects. Obtain the revised dose and restart date in writing. Do not restart leftover medicine because symptoms seem better, and do not stop another prescribed medicine simply because cabozantinib has been paused.

Monitoring and checking whether treatment is working

Early review is important: European information recommends close assessment during the first eight weeks, when many side effects first appear. Blood pressure needs early and regular checks. If you use a home monitor, ask how to measure correctly and which readings require contact. High pressure can be present without a headache.

Blood tests monitor liver function, kidney function, blood counts and salts. Low calcium and other electrolyte changes can affect nerves, muscles and heart rhythm. Thyroid problems may need hormone treatment. Urine tests look for protein loss even if your urine appears normal.

When nivolumab is part of treatment, liver inflammation and adrenal hormone problems require extra attention. The team may test liver enzymes more frequently and investigate symptoms with additional hormone tests. Side effects from the two medicines can overlap, so do not decide which medicine is responsible yourself.

Tell the team about bowel frequency, appetite, weight, mouth pain, walking discomfort and any bleeding. A brief symptom diary helps identify changes before they become disabling. Response assessments remain separate from these safety checks; ask what results will determine whether treatment continues.

Common side effects and practical care

Diarrhoea and nausea

Report diarrhoea early and use only the treatment plan supplied by your team. Record how often it occurs and whether there is blood, pain or fever. Frequent watery stools can cause dehydration and disturb blood salts. If you also receive nivolumab, diarrhoea may represent immune-related bowel inflammation and needs assessment rather than repeated self-treatment alone.

Take small, tolerable meals and prescribed anti-sickness medicines. Discuss a suitable fluid intake; a fixed high target may be inappropriate with heart or kidney disease. Persistent vomiting, inability to drink, dizziness or very little urine requires prompt contact. Severe abdominal pain or a swollen abdomen needs urgent assessment.

Hand–foot symptoms

Hand–foot syndrome can cause soreness, tingling, redness or darker skin, thickened areas, cracks and blisters on palms and soles. Tell the team when walking, holding objects or daily tasks become uncomfortable. A pause or dose adjustment may be needed before the skin breaks down.

Use the moisturiser recommended by your team, wear comfortable footwear and avoid repeated friction, pressure and very hot water. Ask before applying strong corn treatments or removing thickened skin yourself. Report broken skin or signs of infection promptly.

Mouth, taste and appetite changes

Use gentle mouth care and a soft toothbrush. Tell the team about ulcers, pain with swallowing or difficulty eating. Softer foods and avoiding foods that sting may help. Do not assume persistent jaw pain or a non-healing area in the mouth is an ordinary mouth ulcer.

Taste changes, nausea and fatigue can reduce appetite. Smaller frequent meals may be easier, and a dietitian can help if weight is falling. Avoid unnecessary restrictive diets or unverified supplements that make adequate nutrition harder.

Tiredness, skin and other changes

Balance rest with gentle activity within your ability. Report unusually severe fatigue because anaemia, thyroid changes, dehydration or adrenal problems may be contributing. Dry skin, rash, hair thinning or lighter hair colour and changes in the voice can occur. Ask for symptom support rather than stopping treatment without a plan.

Common does not mean harmless. A symptom that prevents drinking, walking, sleeping or managing daily tasks deserves a call, even if you have been told it is an expected side effect.

Important side effects needing prompt assessment

Bleeding, clots and severe abdominal symptoms

Cabozantinib can cause serious bleeding. Vomiting blood, black tar-like stools, significant coughing up of blood or bleeding that will not stop requires emergency assessment. Report smaller new bleeding promptly.

A painful swollen limb may indicate a clot and needs urgent assessment. Chest pain, sudden breathlessness, stroke symptoms or collapse is an emergency. European information also warns about weakened or torn artery walls; sudden severe chest, back or abdominal pain must not be ignored.

A hole in the bowel, called perforation, or an abnormal connection between organs, called a fistula, can occur. Severe or persistent abdominal pain, fever, a rigid or swollen abdomen, or unusual leakage needs urgent investigation. A new cough when swallowing can also warrant assessment for a fistula.

Heart, blood pressure and brain symptoms

Heart failure can occur. Report new breathlessness, ankle swelling, rapid weight gain or difficulty breathing when lying down. Severe breathlessness or chest pain needs emergency care. The team may pause or stop treatment and arrange heart tests.

Severe headache, confusion, seizures or sudden sight changes may reflect dangerously high blood pressure or a rare brain condition called posterior reversible encephalopathy syndrome, also called reversible posterior leukoencephalopathy syndrome. Seek emergency help. The word “reversible” is not a reason to delay assessment.

Liver, kidneys, calcium and adrenal hormones

Yellowing of the skin or eyes, dark urine or persistent upper abdominal pain can indicate liver injury. Foamy urine, swelling or reduced urine may signal kidney problems. Contact the team promptly, even if the next routine blood test is soon.

Low calcium can cause tingling around the mouth, muscle cramps or spasms. Severe spasms, a seizure or an abnormal heartbeat requires urgent care. Take calcium or other replacement only as prescribed; the dose depends on measured levels and your circumstances.

With nivolumab, reduced adrenal hormone production can cause unusual exhaustion, weakness, vomiting, dizziness, low blood pressure or collapse. Report symptoms promptly; collapse needs emergency help. If hormone replacement is prescribed, obtain instructions for illness and emergencies and do not stop it abruptly.

Jaw and wound problems

Jawbone damage can cause persistent jaw pain, loose teeth, swelling or a mouth wound that does not heal. Contact the team and dentist. Dental procedures must be coordinated with oncology. Keep reporting healing problems after treatment stops because the effect does not disappear immediately.

Other medicines, supplements and vaccinations

Cabozantinib interacts with medicines that affect liver enzymes, particularly CYP3A4. Examples include some antibiotics, antifungals, antiviral medicines, seizure medicines and rifampicin. St John's wort can reduce exposure. Avoid grapefruit. The pharmacist may recommend an alternative medicine or a prescribed dose change; do not adjust cabozantinib yourself.

Blood thinners and other medicines with a narrow safe dose range need particular review. European information advises INR monitoring if warfarin is used. Bring hormone contraception, heart medicines, diabetes treatment and supplements to the review. Even a short course prescribed by another clinician should be checked.

Ask about vaccination timing for the whole regimen. Live vaccines may be unsuitable when immunity is reduced, while non-live vaccines may still be recommended. Advice depends on accompanying treatment and your health; do not copy another patient's waiting period.

Everyday life during treatment

Plan meals around the fasting window without missing needed nutrition. A reminder can help with the dose, but also keep a record so an alarm does not lead to an accidental repeat. Arrange repeat supplies early and check the exact formulation at collection.

Adapt footwear and activities if hand–foot symptoms develop. Avoid driving or machinery when tired, weak, dizzy or visually affected. Discuss work involving heat, friction or prolonged standing with the team before symptoms become difficult to manage.

Take your treatment summary when travelling and identify how to obtain urgent help. Do not skip blood-pressure or blood tests to fit a trip without discussing the plan. Ask for support with fatigue, anxiety, appetite, relationships or the practical demands of treatment; these issues matter alongside scan results.

Fertility, pregnancy and breastfeeding

Cabozantinib can harm an unborn baby. Patients who could become pregnant need effective contraception during treatment and for at least four months after the final dose. European information also applies a four-month precaution to male patients and partners who could become pregnant. The US labels do not specify a separate fixed male interval; obtain advice for the supplied product and complete regimen.

European information recommends an additional barrier method when oral hormonal contraception is used because its effectiveness might be reduced. Discuss an appropriate combination of methods, especially if diarrhoea or vomiting occurs. Contact the team promptly if pregnancy is suspected in you or a partner.

Do not breastfeed during cabozantinib treatment or for at least four months afterwards. If nivolumab is included, its US instructions require contraception for patients who could become pregnant and no breastfeeding for five months after the last nivolumab dose. Follow whichever treatment-specific precautions remain in force; a shorter cabozantinib interval must not shorten the partner's precautions.

Fertility may be affected, although the individual outcome cannot be predicted. Ask about sperm or egg preservation before treatment if future parenthood matters to you. Reduced fertility or absent periods does not remove the need for contraception.

After treatment stops or changes

Continue follow-up, agreed contraception and breastfeeding precautions, and any prescribed blood-pressure or hormone treatment. Side effects and wound-healing risks can persist beyond the last dose. Tell surgeons and dentists when treatment stopped.

If nivolumab was included, immune-related problems can begin or continue after treatment ends. Keep its alert information and report new symptoms rather than assuming they cannot be treatment-related. Follow the separate immunotherapy guidance given by your team.

Ask for a written summary of the formulation, dose changes, important side effects, monitoring still needed and the next review. Do not restart stored medicine or use someone else's supply. A planned pause and a permanent stop are different decisions that should be explained clearly.

Frequently asked questions