What is cabozantinib (Cometriq®, Cabometyx®)?

Cabozantinib is a type of targeted therapy drug called a tyrosine kinase inhibitor. It's used to treat medullary thyroid cancer and kidney cancer that has spread.

Cabozantinib (Cometriq®) capsules are used to treat medullary thyroid cancer that cannot be removed with an operation, or that has spread to other parts of the body.

Cabozantinib (Cabometyx®) tablets are used to treat a type of kidney cancer called renal cell cancer that has spread to other parts of the body. They may also be used to treat primary liver cancer.

Cabozantinib may sometimes be used to treat other cancers or as part of a clinical trial.

It’s best to read this information with our general information about the type of cancer you have. During treatment, you will see a cancer doctor and a cancer nurse. This is who we mean when we mention doctor or nurse in this information.

How cabozantinib is given

Cabozantinib comes in tablets or capsules, so you can take it at home.

During treatment you usually see a cancer doctor, a cancer nurse or a specialist nurse, and a specialist pharmacist. This is who we mean when we mention doctor, nurse or pharmacist in this information.

Always take cabozantinib exactly as your nurse or pharmacist explained. This is important to make sure it works as well as possible for you. Your doctor will talk to you about how long to take cabozantinib for.

Taking cabozantinib

You take cabozantinib once a day at the same time each day. Take your tablets or capsules with a glass of water, one hour before you eat or two hours after you eat. Don’t chew or crush the tablets or open the capsules before you take them as this may increase side effects. Avoid eating grapefruit and drinking grapefruit juice during your treatment as it may increase side effects.

If you forget to take your cabozantinib and it is more than 12 hours until the next dose, take it as soon as you remember. If it is less than 12 hours until the next dose, do not take the missed dose – take your usual dose at the usual time the next day. You should never take a double dose.

There are some important things to remember when taking your tablets or capsules:

  • Keep them in the original packaging and at room temperature, away from heat and direct sunlight.
  • Keep them safe and out of sight and reach of children.
  • If your treatment is stopped return any unused capsules or tablets to the pharmacist.

Possible side effects of cabozantinib

We explain the most common side effects of this treatment here. We also include some less common side effects.

You may get some of the side effects we mention, but you are unlikely to get all of them. If you are also having treatment with other cancer drugs, you may have some side effects that we have not listed here. Always tell your doctor, nurse or pharmacist about any side effects you have.

Your doctor can give you drugs to help control some side effects. It is important to take them exactly as your nurse or pharmacist explains. This means they will be more likely to work for you. Your nurse will give you advice about managing your side effects. After your treatment is over, most side effects start to improve.

Serious and life-threatening side effects

Some cancer treatments can cause severe side effects. Rarely, these may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.

Contact the hospital

Your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call them at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.

More information

We cannot list every side effect for this treatment. There are some rare side effects that are not listed. You can visit the electronic Medicines Compendium (eMC) for more detailed information.

Common side effects of cabozantinib

Diarrhoea

If you have diarrhoea,tit can usually be controlled with medicines. Follow any advice you have been given about taking anti-diarrhoea drugs. Tell your doctor if the diarrhoea is severe or if continues after taking the anti-diarrhoea drugs. It is important to drink at least 2 litres (3½ pints) of fluids each day.This stops you getting too dehydrated. It can help to avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods.

Tiredness

Feeling tired is a common side effect. Try to pace yourself and plan your day so you have time to rest. Gentle exercise, like short walks, can give you more energy. If you feel sleepy, do not drive or operate machinery.

Loss of appetite

You may lose your appetite during treatment and may lose weight. Try to eat small meals regularly. If your appetite does not improve after a few days, tell your doctor or nurse. They can arrange for you to see a dietitian, who can give you advice. You may be given food supplements or meal replacement drinks to try. Your doctor can prescribe some of these. You can also buy them from chemists.

Feeling sick

Your doctor can give you anti-sickness drugs to help prevent or control sickness. If you still feel sick, tell your doctor. They can prescribe other anti-sickness drugs that may work better for you.

Tummy pain

You may get pain or discomfort in your tummy (abdomen) or have indigestion. Your doctor can prescribe drugs to help improve these symptoms. Tell them if the pain does not improve or gets worse.

Rarely, cabozantinib can cause a hole (perforation) in the bowel. Contact your doctor straight away if you have:

  • severe pain in your tummy
  • bleeding from the back passage
  • black stools
  • vomiting up blood (or have vomit that looks like coffee grounds).

Sore and red palms of hands and soles of feet

This is called palmar-plantar, or hand-foot syndrome. Always tell your nurse about any changes in your hands or feet. They can give you advice and prescribe creams to improve the symptoms. It may help to keep your hands and feet cool and avoid tight-fitting socks, shoes and gloves. If this side effect is severe, your doctor may tell you to stop taking cabozantinib for a time to let it improve.

Risk of infection

You are more likely to get an infection while taking cabozantinib.

If you have an infection, it is important to treat it as soon as possible. Contact the hospital straight away on the 24-hour contact number you have if:

  • your temperature goes over 37.5°C (99.5°F)
  • you suddenly feel unwell, even with a normal temperature
  • you have symptoms of an infection.

Symptoms of an infection include:

  • feeling shivery
  • a sore throat
  • a cough
  • diarrhoea
  • needing to pass urine often.

Effects on the mouth

You may notice food tastes different while you are taking this treatment. Your nurse can give advice on coping with this. Some people may get a sore mouth or mouth ulcers. Drink plenty of fluids, and clean your teeth regularly and gently with a soft toothbrush. Tell your doctor or nurse if you have any mouth problems. They can prescribe mouthwashes and medicines to treat mouth infections and relieve soreness.

Feeling dry (dehydration)

This treatment may make you feel dry (dehydrated). Tell your doctor or nurse if you have signs of dehydration such as:

  • feeling dizzy or tired
  • passing small amounts of urine
  • dry mouth and eyes.

Dehydration can also affect the levels of minerals and salts in your body. Your doctor will take regular blood tests to check these. It is important to drink plenty of fluids while having this treatment – around 2 litres (3½ pints) a day.

High blood pressure

Cabozantinib can increase your blood pressure. A nurse will check your blood pressure regularly during treatment. If you have headaches, nosebleeds or feel dizzy, let your doctor know. Your doctor can usually prescribe tablets to control high blood pressure. Some people may need to reduce their dose of cabozantinib or stop taking it. Less often, cabozantinib may lower your blood pressure.

Constipation

This treatment can cause constipation. Here are some tips that may help:

  • Drink at least 2 litres (3½ pints) of fluids each day.
  • Eat high-fibre foods, such as fruit, vegetables and wholemeal bread.
  • Do regular gentle exercise, like going for short walks.

If you have constipation, contact the hospital for advice. Your doctor can give you drugs called laxatives to help.

Voice changes

You may notice some voice changes or hoarseness. Talk to your doctor if you are worried about this.

Effects on the hair

Your hair may lose its colour and may become thinner while you are taking this treatment. Changes to your hair are usually temporary and get better if you stop treatment. But for some people, hair changes can be permanent.

Anaemia (low number of red blood cells)

This treatment can reduce the number of red blood cells in your blood. These cells carry oxygen around the body. If the number of red blood cells is low, you may be tired and breathless. Tell your doctor or nurse if you feel like this.

Bleeding

This treatment can sometimes cause bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin. Tell your doctor if you are taking any medicines that may affect bleeding. These include:

  • aspirin
  • blood-thinning tablets such as warfarin
  • injections such as heparin, or vitamin E.

Contact your doctor straight away if you have any unusual bleeding including vomiting or coughing up blood, unexpected vaginal bleeding or blood in your stools (bowel movements).

Slow wound-healing

Wounds often take longer to heal while you are having treatment with this treatment. If you need an operation, your doctor will tell you to stop taking this treatment at least four weeks before you have it.

Effects on the thyroid gland

This treatment can sometimes affect the thyroid gland, making it less active. Your doctor will check how your thyroid is working with regular blood tests. If this happens, it can be easily treated with medication and goes back to normal after the treatment is finished.

Breathlessness and a cough

You may feel more out of breath than normal or develop a cough. Let your doctor know if you notice this.

Skin changes

Your skin may become dry and itchy. You may also notice a rash or redness. Tell your doctor or nurse if you have any of these symptoms. They can prescribe creams and drugs to help.

Joint and muscle pain

You may have pain and stiffness in your joints, and sometimes in your muscles. Tell your doctor or nurse if this happens. They can prescribe painkillers and give you advice.

Build-up of fluid

Your ankles and legs may swell because of fluid building up. If fluid collects in the lining of the lungs (pleural effusion), this may make you breathless. Tell your doctor or nurse if you notice this. They can prescribe medicines to help.

Less common side effects

Hearing changes

This treatment may cause hearing changes, including hearing loss. You may have ringing in the ears. This is called tinnitus. You may also become unable to hear some high-pitched sounds. Hearing changes usually get better after this treatment ends. But some can be permanent. Tell your doctor if you notice any changes in your hearing.

Changes in eyesight

Cabozantinib can cause blurry eyesight. Tell your doctor if you have this side effect.

Numb or tingling hands or feet (peripheral neuropathy)

This treatment may affect the nerves, which can cause numb, tingling or painful hands or feet. You may find it hard to fasten buttons or do other fiddly tasks. The symptoms usually improve slowly after treatment finishes. Talk to your doctor if you are worried about this.

Jaw problems (osteonecrosis)

Rarely, this treatment may cause a condition called osteonecrosis of the jaw. This is when healthy bone tissue in the jaw becomes damaged and dies. Some dental treatments, such as having a tooth removed, can increase the risk. Before you start taking this treatment, you will be advised to have a full dental check-up. Your doctor will advise you to stop taking this treatment for a short time before dental treatments like this. Always tell your dentist that you are taking this treatment.

Heart problems

Sometimes cabozantinib can affect the heart. If you have chest pain or chest tightness, or if your heartbeat becomes less regular or too fast or too slow, contact a doctor straight away.

Effects on the kidneys and liver

This treatment can affect the kidneys and liver. This is usually mild and goes back to normal after treatment. You will have regular blood and urine tests during your treatment to check how well your kidneys and liver are working.

Changes in mood

Sometimes cabozantinib can cause mood changes such as depression or anxiety. If you feel depressed or anxious, or have other changes to your mood, tell your doctor.

Effects on the nervous system

This treatment can affect the nervous system. You may feel confused, dizzy or unsteady. Tell your doctor or nurse straight away if you notice this.

Other information about cabozantinib

Blood clot risk

Cancer and some cancer treatments can increase the risk of a blood clot. Symptoms of a blood clot include:

  • pain, redness or swelling in a leg or arm
  • breathlessness
  • chest pain.

If you have any of these symptoms, contact a doctor straight away.

A blood clot is serious, but can be treated with drugs that thin the blood. Your doctor or nurse can give you more information.

Driving

Do not drive if you have dizziness or blurred vision, or if you feel tired or sleepy. Talk to your doctor if you are not sure whether it is safe for you to drive.

Other medicines

Some medicines can affect this treatment or be harmful when you are having it. This includes medicines you can buy in a shop or chemist. Tell your cancer doctor about any drugs you are taking, including vitamins, herbal drugs and complementary therapies.

Contraception

Your doctor will advise you not to become pregnant or make someone pregnant during treatment or for at least four months after. Cabozantinib may harm a developing baby. Because cabozantinib may make oral contraceptives less effective, your doctor will suggest you also use a barrier method.

Fertility

Some cancer drugs can affect whether you can get pregnant or make someone pregnant. If you are worried about this, it is important to talk with your doctor before you start treatment.

Breastfeeding

Women are advised not to breastfeed during treatment and for at least 4 months afterwards. This is because the drugs could be passed to the baby through breast milk.

Medical and dental treatment

If you need medical treatment for any reason other than cancer, always tell the doctors and nurses that you are having cancer treatment. Give them the contact details for your cancer doctor so they can ask for advice.

If you think you need dental treatment, talk to your cancer doctor or nurse. Always tell your dentist you are having cancer treatment.

Vaccinations

Your doctor or nurse may talk to you about vaccinations. These help reduce your risk of getting infections.

Doctors usually recommend that you have a flu jab, which is an inactivated vaccination. People with weak immune systems can have this type of vaccination.

If your immune system is weak, you need to avoid live vaccinations such as shingles. Your cancer doctor or GP can tell you more about live vaccinations.

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