Cabozantinib (Cometriq®, Cabometyx®)

Cabozantinib is a targeted therapy drug used to treat medullary thyroid cancer and kidney cancer that has spread. 

It is best to read this information with our general information about the type of cancer you have.

It is usually given as tablets or capsules. You usually have it as an outpatient. Your cancer doctor, nurse or pharmacist will tell you how often you will have it.

Like all targeted therapy drugs, cabozantinib can cause side effects. Some of them can be serious, so it is important that you read the detailed information on this page. How targeted therapy affects people varies from person to person. It is important to read about the side effects so that you know what to expect. Your healthcare team can talk to you more about this and give you advice on how to manage any side effects.

Tell your doctor or nurse straight away if you:

  • have a temperature
  • feel unwell
  • have severe side effects, including any we don’t mention here.

If you need to seek medical attention for any reason other than cancer, always tell the healthcare staff that you are having this treatment.

How cabozantinib works

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. 

It works by blocking (inhibiting) the signals inside cancer cells that make them grow and divide. This may help to stop or slow down the growth of the cancer. It can also stop new blood vessels growing in the area of the cancer. Cancer cells need to make new blood vessels so they can grow and spread.

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 targeted therapies work

This animation shows how targeted therapies work and what effect they have on the body.

About our cancer information videos

How targeted therapies work

This animation shows how targeted therapies work and what effect they have on the body.

About our cancer information videos


When cabozantinib is used

Medullary Thyroid Cancer

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

Kidney (renal) cancer

Cabozantinib (Cabometyx®) tablets can be used to treat kidney cancer that has spread to other parts of the body. You have it after other targeted treatments such as pazopanib or sunitinib have been used.

Cabozantinib may only be available in some situations. Your cancer doctor can tell you if it’s appropriate for you. Some people may be given it as part of a clinical trial. If a drug isn’t routinely available on the NHS, there may be other ways you can get access to it.  Your cancer doctor can give you advice. 


Taking cabozantinib

You take cabozantinib as capsules or tablets once a day at the same time each day. Take them 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.

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.

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 in a safe place, out of the reach of children.
  • If your doctor decides to stop the treatment, return any remaining drugs to the pharmacist. Don’t flush them down the toilet or throw them away.


Possible side effects of cabozantinib

We explain the most common side effects of cabozantinib here. We also include less common side effects. You may get some of the side effects we mention, but you are unlikely to get all of them.

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 is important to make sure it works as well as possible 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

You may have frequent or loose bowel movements. This can usually be easily controlled by taking anti-diarrhoea drugs. Your doctor can prescribe these for you. You should tell your doctor if your diarrhoea is severe or if it continues. It is important to drink plenty of fluids if you have diarrhoea, around 2 litres (4 pints) a day.

Feeling tired

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 doesn’t improve or gets worse.

Rarely, cabozantinib can cause a hole (perforation) in the bowel. Tell your doctor straight away if you have sudden or severe pain in your tummy, signs of bleeding from the back passage, black stools, vomit up blood, or have vomit that looks like coffee grounds.

Sore and red hands and feet

Having sore and red palms of hands and soles of feet is called palmar-plantar or hand-foot syndrome. It gets better when treatment ends. Your doctor or nurse can give you advice and prescribe creams to improve the symptoms. It can help to keep your hands and feet cool and to avoid tight-fitting socks, shoes and gloves.

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

You may get constipated. Drinking plenty of fluids, eating more fibre and doing some gentle exercise can help. You may also need to take medicines (laxatives). Talk to your doctor or nurse for more advice.

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.

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.

Voice changes

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

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.

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.

Risk of infection

If you have a low number of white blood cells, you are more likely to get an infection. If this happens during your treatment your doctor or nurse will advise you how to reduce your risk of infection.

Contact the hospital straight away if:

  • your temperature goes over 37.5°C (99.5° F) or over 38°C (100.4° F), depending on the advice given by your healthcare team
  • you suddenly feel unwell, even with a normal temperature
  • you have symptoms of an infection, such as:
    • feeling shaky
    • a sore throat
    • a cough
    • diarrhoea
    • needing to pass urine often.

Anaemia (low number of red blood cells)

This drug 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.

Feeling dry (dehydration)

This treatment may make you feel dry (dehydrated). It 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 treatment with this treatment – around two litres (three and a half pints) a day. Let your doctor or nurse know if you have any signs of dehydration, such as feeling dizzy or tired, passing small amounts of urine, or having a dry mouth and eyes.

Changes in hearing

This treatment can affect your hearing. You may get ringing in your ears (tinnitus). Tinnitus usually gets better after treatment ends. Tell your doctor if you notice any changes in your hearing.

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. Tell your doctor if you have these symptoms.

Increased risk of blood clots

Cancer increases the chances of a blood clot (thrombosis). This treatment can add to this. A clot can cause symptoms such as pain, redness and swelling in a leg, breathlessness and chest pain. Contact your doctor straight away if you have any of these symptoms. A blood clot is serious but your doctor can treat it with drugs that thin the blood. Your doctor or nurse can give you more information.


Less common side effects

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.

Abscess

This treatment may cause a pocket of infection (pus) to collect in the tummy. An abscess can cause pain or swelling. Tell your doctor or nurse if you notice this, have a fever or feel unwell.

Changes to your mood

Some people may have mood changes. These could be depression, anxiety, mood swings, restlessness or difficulty sleeping. If you feel depressed or have other changes to your mood, it is important to tell your doctor straight away.

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

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, including those that you can buy in a shop or chemist, can be harmful to take when you’re having this drug. Tell your doctor about any medicines you’re taking, including drugs that you can buy for yourself, complementary therapies and herbal drugs.

Contraception

Your doctor will advise you not to become pregnant or father a child 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

It’s not known if this drug affects your fertility (being able to get pregnant or father a child). If you are worried about this, talk to your doctor or nurse before treatment starts.

Breastfeeding

Doctors do not know whether this drug may be present in breast milk, so women are advised not to breastfeed during treatment and for a few months afterwards.

Medical and dental treatment

If you need to go into hospital for any reason other than cancer, always tell the doctors and nurses you are taking this drug. Give them the name of your cancer doctor so they can ask for advice.

Talk to your cancer doctor or nurse if you think you need dental treatment. Always tell your dentist the names of your cancer medicines.