CABOZAMED
Cabozantinib 40/60mg
Net Qty- 30 tablet
Self-Life- 2 Years
💊 Cabozamed (Cabozantinib) Tablet belongs to the class of medicines known as tyrosine kinase inhibitors used in the treatment of liver cancer, kidney cancer, and thyroid cancer.
🧬 Cabozamed (Cabozantinib)
Drug Class: Tyrosine kinase inhibitor (TKI)
Used for: Various cancers, especially those with resistance to first-line therapies.
USE
✅ Cabozamed (Cabozantinib) is used to treat several types of advanced cancers, particularly where the disease has spread (metastatic) or no longer responds to prior treatments.
📌 Advanced Renal Cell Carcinoma (RCC) – Kidney Cancer
First-line: In combination with nivolumab
Second-line: As monotherapy after progression on prior VEGF therapy
Helps improve progression-free survival and overall survival
📌 Hepatocellular Carcinoma (HCC) – Liver Cancer
Used in patients who have already been treated with sorafenib
Shown to slow disease progression and improve survival
📌 Medullary Thyroid Carcinoma (MTC)
For progressive, metastatic, or symptomatic MTC
Used in patients not eligible for surgery
⚠️ Off-label/Investigational Uses (in clinical trials):
Non-small cell lung cancer (NSCLC)
Metastatic castration-resistant prostate cancer
Breast cancer
Colorectal cancer
Sarcomas
Key Benefits
🌟 Key Benefits of Cabozamed (Cabozantinib)
Cabozamed (Cabozantinib) offers several important benefits for patients with advanced cancers, especially when previous therapies have failed or are no longer effective.
✅ Multi-Targeted Action
Inhibits multiple tyrosine kinases (e.g., VEGFR, MET, AXL, RET), which are involved in:
Tumor growth
Angiogenesis (formation of blood vessels that supply the tumor)
Invasion and metastasis
✅ Proven Survival Benefit
Shown to prolong progression-free survival (PFS) and overall survival (OS) in:
Advanced renal cell carcinoma (RCC)
Hepatocellular carcinoma (HCC)
Medullary thyroid cancer (MTC)
✅ Effective After Other Therapies Fail
Works in patients who have progressed after other treatments (like sorafenib or VEGF inhibitors)
An important option for treatment-resistant cancers
✅ Oral Administration
Available as oral tablets or capsules
Allows for at-home treatment, avoiding frequent hospital visits
✅ Synergistic in Combination Therapies
Shown to work well in combination with immune checkpoint inhibitors (e.g., nivolumab), improving response rates and delaying progression
Offers clinical benefit in various solid tumors beyond kidney and liver cancers, including thyroid, prostate, and lung cancers (in trials)
Mechanism
of Action
🧬 Cabozamed (Cabozantinib) – Mechanism of Action
Cabozamed (Cabozantinib) is a multi-targeted tyrosine kinase inhibitor (TKI) that works by blocking several pathways critical for tumor growth, spread, and angiogenesis (blood vessel formation).
🔑 Targets Inhibited by Cabozamed (Cabozantinib):
VEGFR (1, 2, 3) – Vascular Endothelial Growth Factor Receptors
Inhibits angiogenesis (tumor blood supply)
MET – Hepatocyte Growth Factor Receptor
Reduces tumor cell growth, invasion, and metastasis
AXL – TAM family receptor tyrosine kinase
Associated with drug resistance and metastatic potential
RET – Rearranged During Transfection
Especially important in medullary thyroid cancer
KIT, FLT3, ROS1, TYRO3, and TRKB – Additional kinases involved in cancer signaling
🛠️ How It Works:
Blocks signaling pathways that promote:
Tumor cell proliferation
New blood vessel formation
Invasion and metastasis
Starves tumors of oxygen and nutrients
Suppresses survival signals within cancer cells
🧪 Result:
Tumor shrinkage or slowed growth
Reduced spread of cancer
Improved survival outcomes in several cancer types
Dosage and Administration
💊 Cabozamed (Cabozantinib) – Dosage and Administration
Cabozamed (Cabozantinib) is available in two distinct oral formulations, each specific to certain types of cancer. It’s important to never substitute tablets for capsules or vice versa, as they are not bioequivalent.
📌 Cabozamed (Cabozantinib) (Tablets)
Indications:
Advanced Renal Cell Carcinoma (RCC)
Hepatocellular Carcinoma (HCC) (after sorafenib)
✅ Recommended Dose:
60 mg orally once daily
⚠️ Administration Instructions:
Take on an empty stomach
No food for ≥2 hours before and ≥1 hour after
Swallow tablet whole with water
Take at the same time each day
📌 Cabozamed (Cabozantinib) (Capsules)
Indication:
Medullary Thyroid Carcinoma (MTC)
✅ Recommended Dose:
140 mg orally once daily
Typically given as one 80 mg + one 60 mg capsule
⚠️ Administration Instructions:
Also taken on an empty stomach
Capsules must be swallowed whole — do not open or chew
Take at a consistent time daily
🔁 Missed Dose Instructions:
If a dose is missed and less than 12 hours have passed: take it as soon as possible
If more than 12 hours have passed: skip the dose and take the next one at the usual time
Do not double up to make up for a missed dose
🛠️ Dose Adjustments May Be Needed For:
Toxicity or adverse effects (e.g., diarrhea, fatigue, hand-foot syndrome)
Hepatic impairment
Drug interactions with CYP3A4 inducers/inhibitors
Common Side Effects
⚠️ Common Side Effects of Cabozamed (Cabozantinib)
Cabozamed (Cabozantinib), like other targeted cancer therapies, can cause a variety of side effects — most of which are manageable with supportive care or dose adjustments. Here’s what patients and caregivers should be aware of:
🩺 Very Common Side Effects (≥20% of patients):
| Side Effect | Description / Notes |
|---|---|
| Diarrhea | Often occurs early; managed with antidiarrheals |
| Fatigue | One of the most reported symptoms |
| Mouth sores (stomatitis) | Can affect eating and speaking |
| Decreased appetite | May lead to weight loss |
| Hypertension (high blood pressure) | Requires regular monitoring and treatment |
| Palmar-plantar erythrodysesthesia (hand-foot syndrome) | Redness, swelling, pain of palms/soles |
| Nausea/Vomiting | Managed with antiemetics if needed |
| Weight loss | Secondary to decreased appetite or GI effects |
| Hoarseness | Due to laryngeal or mucosal irritation |
| Proteinuria | May be seen in lab results — monitor kidneys |
| Elevated liver enzymes (AST/ALT) | Indicates liver irritation — monitor regularly |
🧪 Lab Abnormalities (May Not Cause Symptoms Immediately):
Hypocalcemia, hypophosphatemia, low platelets (thrombocytopenia)
Elevated creatinine – monitor kidney function
Increased TSH – monitor thyroid function, especially in thyroid cancer
🚩 Less Common but Serious Side Effects:
Gastrointestinal perforation or fistula
Severe bleeding
Thromboembolism (e.g., DVT, pulmonary embolism)
QT prolongation (heart rhythm changes)
📌 When to Call the Doctor:
Severe or persistent diarrhea or vomiting
Signs of bleeding (e.g., black stools, coughing blood)
Sudden swelling, chest pain, or shortness of breath
Severe fatigue, yellowing of skin/eyes (liver warning signs)
Monitoring
🔍 Cabozamed (Cabozantinib) – Monitoring Guidelines
Proper monitoring is essential while a patient is on Cabozamed (Cabozantinib) to manage side effects, adjust doses if needed, and ensure the drug is working effectively. Here’s what healthcare providers and patients should keep an eye on:
📆 Baseline (Before Starting Treatment):
Blood pressure
Complete blood count (CBC)
Liver function tests (LFTs) – AST, ALT, bilirubin
Kidney function tests – creatinine, BUN, urine protein
Electrolytes – calcium, phosphate, magnesium, potassium
TSH (thyroid function) – especially important in thyroid cancer
ECG (if risk of QT prolongation)
Weight and nutritional status
🩺 Ongoing Monitoring (During Treatment):
| Parameter | Frequency | Why It’s Important |
|---|---|---|
| Blood pressure | Every 1–2 weeks initially, then regularly | To detect treatment-related hypertension |
| Liver enzymes (AST/ALT, bilirubin) | Every 2–4 weeks | To monitor for liver toxicity |
| CBC (WBC, hemoglobin, platelets) | Monthly | To catch cytopenias like anemia or thrombocytopenia |
| Renal function (creatinine, proteinuria) | Every 4–6 weeks | To monitor for nephrotoxicity |
| TSH | Every 4–6 weeks | For thyroid dysfunction (hypothyroidism) |
| Electrolytes (Ca, Mg, K, Phos) | Periodically | To prevent cardiac/neuro complications |
| ECG | As needed | If on QT-prolonging drugs or cardiac symptoms |
| Body weight / nutrition | Ongoing | Watch for appetite loss or weight drop |
🚨 Additional Monitoring if Symptoms Arise:
Mouth ulcers: Inspect oral mucosa
Hand-foot syndrome: Check for skin breakdown or rash
Signs of bleeding or clotting: Assess promptly
Precautions
⚠️ Cabozamed (Cabozantinib) – Precautions
Before and during treatment with Cabozamed (Cabozantinib), several precautions should be taken to minimize risks and ensure safe use of the drug. Here’s what healthcare professionals and patients should be aware of:
🧠 General Precautions
Formulation differences:
Do not interchange Cabozamed (tablets) with Cabozamed (capsules). They are not bioequivalent.Empty stomach requirement:
Must be taken without food (at least 2 hours before and 1 hour after eating) to ensure proper absorption.
💉 Medical Conditions to Monitor Closely:
| Condition | Reason for Caution |
|---|---|
| Hypertension | Cabozantinib can cause or worsen high blood pressure |
| Bleeding disorders or on anticoagulants | Increased risk of serious bleeding |
| History of thromboembolism | May raise risk of blood clots |
| Liver disease | Higher drug levels; may need dose adjustment |
| Kidney impairment | Use cautiously; monitor function |
| Cardiac conditions | Risk of QT prolongation and cardiac events |
| Wound healing | May impair healing; stop treatment before major surgery |
🚨 Surgery-Related Precaution
Hold cabozantinib at least 28 days before elective surgery
Restart only after adequate wound healing
👶 Use in Special Populations:
| Group | Precaution |
|---|---|
| Pregnancy | Not recommended; may cause fetal harm (Category D) |
| Breastfeeding | Avoid — unknown if drug passes into milk |
| Pediatrics | Safety not established |
| Elderly | Monitor more closely due to higher risk of toxicity |
🍊 Drug & Food Interactions:
Avoid grapefruit/grapefruit juice – can raise cabozantinib levels
Be cautious with CYP3A4 inhibitors/inducers (e.g., ketoconazole, rifampin)
Drug Interactions
💊 Cabozamed (Cabozantinib) – Drug Interactions
Cabozamed (Cabozantinib) is metabolized mainly through the CYP3A4 liver enzyme pathway, so it can interact with many commonly used medications, increasing the risk of side effects or reducing effectiveness.
🔄 CYP3A4 Inhibitors – ⚠️ May Increase Cabozantinib Levels
These drugs slow the breakdown of Cabozamed (Cabozantinib), leading to higher exposure and potentially more side effects.
| Drug Class | Examples |
|---|---|
| Antifungals | Ketoconazole, Itraconazole, Voriconazole |
| Macrolide antibiotics | Clarithromycin, Erythromycin |
| HIV protease inhibitors | Ritonavir, Atazanavir |
| Certain antidepressants | Fluoxetine, Nefazodone |
🔄 CYP3A4 Inducers – ⚠️ May Decrease Cabozantinib Levels
These drugs speed up metabolism, potentially making cabozantinib less effective.
| Drug Class | Examples |
|---|---|
| Anticonvulsants | Phenytoin, Carbamazepine, Phenobarbital |
| Rifamycins | Rifampin, Rifabutin |
| Herbal supplements | St. John’s Wort |
📌 Action: Avoid co-administration or consider increasing Cabozamed (Cabozantinib) dose cautiously.
🔄 Drugs That Increase Bleeding Risk
Cabozamed (Cabozantinib) already increases the risk of bleeding. These drugs compound that risk:
Anticoagulants (e.g., warfarin, apixaban)
Antiplatelets (e.g., aspirin, clopidogrel)
NSAIDs (e.g., ibuprofen, naproxen)
📌 Action: Monitor for signs of bleeding; use with caution.
🔄 QT Prolonging Agents
Cabozamed (Cabozantinib) may prolong the QT interval; co-use with other QT-prolonging drugs may increase arrhythmia risk.
Examples: Amiodarone, Sotalol, Haloperidol, Ziprasidone, certain fluoroquinolones
📌 Action: Monitor ECG if used together.
🍊 Food Interactions
- Avoid grapefruit juice – potent CYP3A4 inhibitor
Clinical Effectiveness
📊 Cabozamed (Cabozantinib) – Clinical Effectiveness
Cabozantinib has demonstrated significant clinical benefit in multiple types of cancer by improving survival outcomes and delaying disease progression. Its effectiveness is supported by several large phase 2 and 3 clinical trials.
✅ Renal Cell Carcinoma (RCC)
Study: METEOR trial (Phase 3)
Compared Cabozamed (Cabozantinib) vs. everolimus in advanced RCC
Result:
Progression-Free Survival (PFS): 7.4 months vs. 3.8 months
Overall Survival (OS): 21.4 months vs. 16.5 months
Overall Response Rate (ORR): 17% vs. 3%
📌 Conclusion: Cabozamed (Cabozantinib) significantly improved PFS and OS in patients who had previously received VEGF-targeted therapy.
✅ Hepatocellular Carcinoma (HCC)
Study: CELESTIAL trial (Phase 3)
Patients previously treated with sorafenib
Result:
Overall Survival: 10.2 months Cabozamed (Cabozantinib) vs. 8.0 months (placebo)
PFS: 5.2 vs. 1.9 months
ORR: ~4%
📌 Conclusion: Showed statistically significant survival benefit in second-line HCC.
✅ Medullary Thyroid Cancer (MTC)
Study: EXAM trial
Advanced/metastatic MTC patients
Result:
PFS: 11.2 months vs. 4.0 months (placebo)
Improved disease control and tumor shrinkage
📌 Conclusion: Cabozantinib improved disease control in progressive MTC.
🧬 Mechanistic Benefit
Cabozamed (Cabozantinib) ability to inhibit multiple kinases (VEGFR, MET, AXL, RET) makes it especially effective in tumors with resistance to single-target TKIs.
🏁 Bottom Line:
Cabozamed (Cabozantinib):
Improves survival and slows tumor progression
Effective in RCC, HCC, and MTC (FDA-approved)
Shows benefit even in heavily pretreated patients
Tips for Patients
💡 Cabozamed (Cabozantinib) – Tips for Patients
If you or someone you care for is starting Cabozamed (Cabozantinib), here are some practical and safety-focused tips to help with daily use and side effect management:
📅 Take It the Right Way
-
Take on an empty stomach
⏱️ No food for 2 hours before and 1 hour after -
Take at the same time each day
-
Swallow whole – do not crush, chew, or open tablets or capsules
-
Don’t mix Cabozamed (Cabozantinib) tablets with Cabozamed (Cabozantinib) capsules — they are not interchangeable
📖 Track Side Effects Early
-
Keep a diary of symptoms (especially diarrhea, fatigue, appetite changes)
-
Report mouth sores, hand-foot pain, or high blood pressure symptoms right away
-
Stay hydrated and eat small, nutrient-dense meals to help with appetite loss or nausea
💊 Be Careful with Other Medications
-
Tell your doctor about all meds, including OTC drugs, supplements, or herbal products (like St. John’s Wort)
-
Avoid grapefruit juice — it can affect Cabozamed (Cabozantinib) levels
-
Be extra cautious with blood thinners, pain relievers (NSAIDs), and other cancer meds
💉 Surgery or Dental Work?
-
Inform your healthcare provider before any planned surgeries
➤ Cabozamed (Cabozantinib) should be stopped at least 28 days before surgery -
It can interfere with wound healing
🚨 Know When to Call Your Doctor
Contact your healthcare team immediately if you experience:
-
Severe diarrhea or vomiting
-
Bleeding or unusual bruising
-
Chest pain, shortness of breath, or swelling
-
Signs of liver problems (yellowing of skin/eyes, dark urine)
-
New or worsening fatigue
🤝 Stay Connected
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Regular lab tests and blood pressure checks are needed
-
Never change your dose without your doctor’s guidance
-
Keep all follow-up appointments to monitor response and side effects